Bretagne J F, Darnault P, Raoul J L, Gandon Y, Duvauferrier R, Launois B, Gastard J
Gastroenterol Clin Biol. 1987 Jun-Jul;11(6-7):453-9.
The authors report 6 cases of portal hypertension with gastrorenal shunt. This shunt did not arise from the left gastric vein, but from the splenic vein. Portal hypertension was related to alcoholic cirrhosis in 3 cases, to extensive portal thrombosis in 2 cases, and to nodular regenerative hyperplasia of the liver in one case. A gastrointestinal hemorrhage revealed portal hypertension and the liver disease in the 3 cases of alcoholic cirrhosis and complicated the course of the disease in the other cases. Hemorrhage was either massive and life-threatening or often recurred. It was related to a rupture of fundic varices in all cases. The fundic varices were not associated with esophageal varices in the 3 cases of cirrhosis. The degree of portal hypertension was above 20 mm Hg, as assessed by the portohepatic gradient (one case), or the pressure gradient between a tributary portal system vein and the inferior vena cava during laparotomy (5 cases). Definitive control of hemorrhage could not be achieved by endoscopic variceal sclerotherapy (2 cases) or percutaneous transhepatic embolization (one case). Portacaval shunt or splenectomy was performed in 5 cases. These findings suggest that spontaneous splenogastrorenal shunt is a clinical and hemodynamic entity which requires specific treatment when associated with gastric variceal bleeding.
作者报告了6例伴有胃肾分流的门静脉高压症病例。这种分流并非源于胃左静脉，而是源于脾静脉。门静脉高压症在3例中与酒精性肝硬化有关，2例与广泛的门静脉血栓形成有关，1例与肝脏的结节性再生性增生有关。在3例酒精性肝硬化病例中，胃肠道出血揭示了门静脉高压症和肝脏疾病，在其他病例中则使疾病进程复杂化。出血要么量大且危及生命，要么经常复发。在所有病例中，出血均与胃底静脉曲张破裂有关。在3例肝硬化病例中，胃底静脉曲张与食管静脉曲张无关。通过肝门静脉梯度（1例）或剖腹手术期间门静脉系统分支静脉与下腔静脉之间的压力梯度（5例）评估，门静脉高压程度超过20 mmHg。内镜下静脉曲张硬化疗法（2例）或经皮经肝栓塞术（1例）均无法最终控制出血。5例患者接受了门腔分流术或脾切除术。这些发现表明，自发性脾-胃肾分流是一种临床和血流动力学实体，当与胃静脉曲张出血相关时需要进行特殊治疗。
