Esquivel C O, Klintmalm G, Iwatsuki S, Makowka L, Gordon R D, Tzakis A, Starzl T E
Surgery. 1987 Apr;101(4):430-2.
Patent distal splenorenal shunts (Warren shunt) have been reported to cause decreases in the portal perfusion pressure and the total hepatic blood flow. Such hemodynamic alterations could have adverse effects on the transplanted liver. The experience with hepatic replacement in four patients with patent Warren shunts is reported. Operative findings were phlebosclerotic portal veins of small size and diminished portal blood flows. Hepatofugal collateral channels created by the construction of the Warren shunt were eliminated by division of the shunt and splenectomy in three patients and splenectomy alone in the other. All patients recovered; thus the presence of a patent Warren shunt should not be a contraindication for hepatic transplantation.
据报道，有效的脾肾分流术（Warren分流术）会导致门静脉灌注压和肝脏总血流量降低。这种血流动力学改变可能会对移植肝脏产生不利影响。本文报道了4例存在有效的Warren分流术的患者进行肝脏置换的经验。手术发现门静脉呈静脉硬化且管径较小，门静脉血流减少。3例患者通过切断分流术和脾切除术消除了由Warren分流术形成的肝外分流通道，另1例仅行脾切除术。所有患者均康复；因此，存在有效的Warren分流术不应成为肝移植的禁忌证。
