Herz R, Halbfass H J, Rössle M, Waldmann D, Gerok W
Klin Wochenschr. 1985 May 2;63(9):409-18. doi: 10.1007/BF01733666.
The effect of the mesocaval interposition shunt (n = 12) and the distal splenorenal shunt (n = 9) on the wedged hepatic venous pressure, the estimated hepatic blood flow, quantitative hepatic function, and the rate of portal systemic encephalopathy was evaluated in 21 patients who had bled from esophageal varices. After mesocaval shunt the wedged hepatic venous pressure was significantly reduced by 42% (from 26 +/- 3 mm Hg to 15 +/- 5 mm Hg, P less than 0.001) compared to 16% only (from 25 +/- 3 mm Hg to 21 +/- 2 mm Hg, P less than 0.005) after distal splenorenal shunt. The estimated hepatic blood flow also decreased significantly after mesocaval shunt by 61% (from 1.45 +/- 0.46 l/min to 0.56 +/- 0.25 l/min, P less than 0.001) compared to 29% (from 1.29 +/- 0.32 l/min to 0.91 +/- 0.39 l/min, P less than 0.05) after distal splenorenal shunt. Despite significantly different influences of both types of shunt operations on wedged hepatic venous pressure and estimated hepatic blood flow (P less than 0.001), postoperative changes of hepatic function were comparable in both groups of patients. The galactose elimination capacity, the initial plasma disappearance rate of Bromsulphalein, and the plasma ratio of valine, leucine, and isoleucine to phenylalanine and tyrosine were reduced by 13%, 26%, and 29%, respectively, after mesocaval shunt, compared to 12%, 25%, and 17% after distal splenorenal shunt. Only two patients of the mesocaval shunt group with the largest decrease in estimated hepatic blood flow developed portal systemic encephalopathy postoperatively, and the distal splenorenal shunt patients with their minor hemodynamic sequelae remained free of portal systemic encephalopathy.
对21例因食管静脉曲张出血的患者，评估了腔静脉分流术（n = 12）和远端脾肾分流术（n = 9）对肝静脉楔压、估计肝血流量、定量肝功能以及门体性脑病发生率的影响。与远端脾肾分流术后仅降低16%（从25±3 mmHg降至21±2 mmHg，P＜0.005）相比，腔静脉分流术后肝静脉楔压显著降低42%（从26±3 mmHg降至15±5 mmHg，P＜0.001）。与远端脾肾分流术后降低29%（从1.29±0.32 l/min降至0.91±该文档为医学专业学术文献翻译任务，要求将英文准确翻译为中文，无需添加额外解释或说明。请严格按照要求输出译文。0.39 l/min，P＜0.05）相比，腔静脉分流术后估计肝血流量也显著降低61%（从1.45±0.46 l/min降至0.56±0.25 l/min，P＜0.001）。尽管两种分流手术对肝静脉楔压和估计肝血流量的影响存在显著差异（P＜0.001），但两组患者术后肝功能变化相当。腔静脉分流术后，半乳糖清除能力、磺溴酞钠初始血浆消失率以及缬氨酸、亮氨酸和异亮氨酸与苯丙氨酸和酪氨酸的血浆比值分别降低了13%、26%和29%，而远端脾肾分流术后分别降低了12%、25%和17%。腔静脉分流组中估计肝血流量下降最大的仅2例患者术后发生了门体性脑病，而远端脾肾分流患者血流动力学后遗症较小，未发生门体性脑病。
