Department of Abdominal Transplant Surgery and Coordination, University Hospitals Leuven, Leuven, Belgium.
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
Acta Chir Belg. 2021 Aug;121(4):254-260. doi: 10.1080/00015458.2020.1726099. Epub 2020 Feb 13.
Extrahepatic portal vein thrombosis (PVT) is the most common cause of portal hypertension (PH), particularly in children. PH-related manifestations include refractory variceal bleeding, splenomegaly and ascites. Albeit more rarely performed, the distal splenorenal shunt (Warren's shunt) has proven to be effective in selectively decompressing the collateral circulation. The aim of our study was to describe our experience with the distal splenorenal shunt and to determine the long-term effect on PH-related side-effects.
Distal splenorenal shunt operations performed at our institution between 2000 and 2014 were reviewed for: age, male/female ratio, children/adults ratio, body mass index, indications, grade of PVT (Yerdel classification), maximal shunt-flow velocity, shunt patency and thrombosis, re-intervention for variceal bleeding and survival. Complications of PH (esophageal variceal bleeding and ascites) were compared pre- post-operatively (last follow-up). Paired student -test and fisher's exact were applied for pre- post-operative comparison. Results are reported as median [range].
Fourteen patients with PVT and refractory complications of PH underwent distal splenorenal shunt surgery. Age was 15 years [4.5-66]. Male/female ratio was 7/7. PVT -grade was 2 [1-4]. Follow-up was 3 [0.5-14]. All shunts were patent (100%) with no shunt thrombosis (0%) at last follow-up. There was no re-intervention for variceal bleeding (0%) and survival at last follow-up was 100%. Occurrence of esophageal variceal bleeding was higher pre-operatively (57%) than postoperatively (0%) ( = .0032) and also the incidence of ascites was higher pre-operatively (79%) than postoperatively (0%) ( < .0001).
Based on our experience, the distal splenorenal shunt can be considered a valuable surgical technique for PVT-induced PH, with excellent post-operative prevention of complications of PH.
肝外门静脉血栓形成（PVT）是门静脉高压（PH）最常见的原因，尤其是在儿童中。PH 相关表现包括难治性静脉曲张出血、脾肿大和腹水。尽管远侧脾肾分流术（Warren 分流术）的应用更为少见，但已被证明可有效地选择性减压侧支循环。我们的研究目的是描述我们在远侧脾肾分流术方面的经验，并确定其对 PH 相关副作用的长期影响。
回顾了 2000 年至 2014 年期间在我们机构进行的远侧脾肾分流术：年龄、男女比例、儿童/成人比例、体重指数、适应证、PVT 程度（Yerdel 分类）、最大分流流速、分流通畅性和血栓形成、静脉曲张出血的再干预以及存活率。比较了 PH 并发症（食管静脉曲张出血和腹水）术前和术后（最后一次随访）的情况。采用配对学生 t 检验和 Fisher 确切概率法进行术前和术后比较。结果以中位数[范围]表示。
14 例 PVT 伴 PH 难治性并发症的患者行远侧脾肾分流术。年龄 15 岁[4.5-66]。男女比例为 7/7。PVT 程度为 2[1-4]。随访时间 3 年[0.5-14]。所有分流术均通畅（100%），最后一次随访时无分流术血栓形成（0%）。无静脉曲张出血再干预（0%），最后一次随访时存活率为 100%。术前食管静脉曲张出血发生率（57%）高于术后（0%）（ = .0032），且术前腹水发生率（79%）高于术后（0%）（ < .0001）。
根据我们的经验，远侧脾肾分流术可被视为治疗 PVT 引起的 PH 的一种有价值的手术技术，可极好地预防 PH 的术后并发症。
