Mosimann R, Loup P
Am J Surg. 1977 Feb;133(2):163-8. doi: 10.1016/0002-9610(77)90072-1.
Analysis of twenty-two patients who underwent distal splenorenal anastomosis shows that the operative mortality and morbidity are low if the indications for the procedure are strictly adhered to. The decompression of the esophageal varicosities is effective, even in the presence of persistent varicosities. This decompression is probably less important and perhaps slower than after portacaval shunting, so we now do not recommend distal splenorenal shunting as an emergency operation. Thrombosis of the shunt is rare and related especially to local anatomic conditions and operative technic. Shunt thrombosis is an early complication that we observed on two occasions manifested by recurrence of hemorrhage. There does not appear to be an appreciable difference between the terminoterminal and terminolateral distal splenorenal anastomoses. The effect of ligation of the splenic artery in the hypersplenism is doubtful. The frequency of postanastomotic encephalopathy is minimal with this type of shunt. Liver function tests were little changed during the period of postoperative observation, but our results do not permit us to conclude that the distal spleno-renal anastomosis less unfavorably affects liver function than do classic shunts.
对22例行远端脾肾静脉吻合术的患者进行分析表明，如果严格遵循该手术的适应症，手术死亡率和发病率较低。即使存在持续性静脉曲张，食管静脉曲张的减压也是有效的。这种减压可能不如门腔分流术后重要，也许起效更慢，所以我们现在不推荐将远端脾肾分流术作为急诊手术。分流血栓形成罕见，尤其与局部解剖条件和手术技术有关。分流血栓形成是一种早期并发症，我们曾两次观察到其表现为出血复发。端端和端侧远端脾肾吻合术之间似乎没有明显差异。脾动脉结扎在脾功能亢进中的效果值得怀疑。这种类型的分流术后吻合口后脑病的发生率极低。术后观察期间肝功能检查变化不大，但我们的结果不允许我们得出远端脾肾吻合术对肝功能的影响比经典分流术更有利的结论。
