Lafortune M, Patriquin H, Pomier G, Huet P M, Weber A, Lavoie P, Blanchard H, Breton G
AJR Am J Roentgenol. 1987 Oct;149(4):701-6. doi: 10.2214/ajr.149.4.701.
Forty-five patients with 46 surgical portosystemic shunts were examined by duplex Doppler sonography, and the results were compared with those of esophageal endoscopy, angiography, surgery, and clinical follow-up. Thirty-eight shunts were patent, and in 33 of these, the shunt was directly visualized and flow was observed with Doppler sonography. Eight shunts were obstructed. After a successful portosystemic shunt procedure, flow in the shunted splanchnic vein was directed toward the shunt and the systemic vein. We studied the intrahepatic portal venous circulation in all of the patients; we found that in the presence of patent portosystemic shunt, portal flow is hepatofugal. This reversal of blood flow occurred in all but four patients. In the end-to-side portacaval shunt, where the portal vein is ligated, blood in intrahepatic portal branches presumably reaches the shunt through perihepatic collaterals. In the presence of a thrombosed shunt, intrahepatic portal venous flow was hepatopetal. To our knowledge, this is the first noninvasive in vivo study of intrahepatic portal circulation after portosystemic shunt surgery. The duplex Doppler evaluation of portosystemic shunts appears to be reliable and should be the method of choice for shunt patency assessment in patients with recurrent signs of portal hypertension. In addition to demonstrating flow at the site of the anastomosis, the Doppler study may yield an easy and reliable sign of shunt patency: reversed flow (hepatofugal flow) in the intrahepatic portal veins probably signals a patent shunt, even if the site of the anastomosis cannot be visualized directly by sonography.
对45例接受了46次外科门体分流术的患者进行了双功多普勒超声检查，并将结果与食管内镜检查、血管造影、手术及临床随访结果进行了比较。38个分流道通畅，其中33个分流道可通过多普勒超声直接观察到分流并检测到血流。8个分流道阻塞。成功实施门体分流术后，分流的内脏静脉血流流向分流道和体静脉。我们研究了所有患者的肝内门静脉循环；发现存在通畅的门体分流时，门静脉血流是离肝的。除4例患者外，所有患者均出现了这种血流逆转。在门静脉被结扎的端侧门腔分流术中，肝内门静脉分支的血液可能通过肝周侧支循环到达分流道。存在血栓形成的分流道时，肝内门静脉血流是向肝的。据我们所知，这是首次对门体分流术后肝内门静脉循环进行的非侵入性体内研究。双功多普勒对门体分流的评估似乎是可靠的，应该是评估门静脉高压复发体征患者分流道通畅情况的首选方法。除了显示吻合部位的血流外，多普勒研究可能会得出一个简单可靠的分流道通畅标志：即使超声无法直接观察到吻合部位，肝内门静脉的反向血流（离肝血流）可能也表明分流道通畅。
