Dudley F J, Young G P, McInnes I E
Aust N Z J Med. 1978 Aug;8(4):413-6. doi: 10.1111/j.1445-5994.1978.tb04913.x.
A 45-year-old male with chronic active hepatitis and portal hypertension had a mesocaval interposition graft performed because of repeated uncontrolled bleeding from oesophageal varices. Acute hepatocellular failure, manifested by Grade IV encephalopathy and severe coagulopathy, developed early in the post-operative course despite the absence of hepatic necrosis or other precipitating factors. Both encephalopathy and coagulopathy resolved rapidly following ligation of the shunt. Variceal bleeding recurred and nine months later an emergency distal lienorenal shunt was performed. Post-operatively the shunt was shown to be patent and there has been no encephalopathy or recurrence of variceal bleeding. It is concluded that (1) the splanchnic haemodynamic effects of a mesocaval interposition graft can result in severe hepatocellular failure and this can be reverted by shunt ligation and (2) the distal lienorenal shunt, while effectively reducing the risk of haemorrhage from varices, may be less likely to result in post-operative encephalopathy than more conventional forms of portal decompressive surgery.
一名患有慢性活动性肝炎和门静脉高压症的45岁男性，因食管静脉曲张反复出血且无法控制，接受了肠系膜上腔静脉搭桥手术。尽管没有肝坏死或其他诱发因素，但术后早期仍出现了以IV级脑病和严重凝血功能障碍为表现的急性肝细胞衰竭。分流结扎后，脑病和凝血功能障碍迅速缓解。静脉曲张出血复发，九个月后进行了急诊远端脾肾分流术。术后显示分流通畅，未出现脑病或静脉曲张出血复发。结论为：（1）肠系膜上腔静脉搭桥术的内脏血流动力学效应可导致严重的肝细胞衰竭，而分流结扎可使其逆转；（2）远端脾肾分流术在有效降低静脉曲张出血风险的同时，与更传统的门静脉减压手术相比，术后发生脑病的可能性可能较小。
