Stipa S, Thau A, Schillaci A, Ziparo V, Rossi P, Passariello R
Surg Gynecol Obstet. 1978 Mar;146(3):391-9.
Seventy-nine mesocaval shunts using the internal jugular vein and 54 side-to-side portocaval shunts have been performed during the past six years. Patients were evaluated from the stand-point of protection from recurrent bleeding, patency of the shunt, encephalopathy, rehabilitation and long term survival. All of the patients underwent follow-up observation. In a selected group of patients, postoperative angiographic control was performed, and serum levels of octopamine were examined. In the mesentericocaval group, patency of the shunt was demonstrated in 82 per cent, the incidence of encephalopathy was 35 per cent and the long term survival rate, as computed by the actuarial method, was 65 per cent. In the portocaval group, the incidence of encephalopathy was 54 per cent and the survival rate, 38 per cent. There was no correlation between octopamine serum levels and encephalopathy. Persistent perfusion of the liver was documented in 95 per cent of the patents controlled by arteriography in the mesentericocaval group with patent shunts. The mesentericocaval shunt seems to be an effective technique in terms of incidence of encephalopathy and survival rate, but a randomized study will be necessary to prove that this technique is more effective than the standard portocaval shunt.
在过去六年中，共进行了79例使用颈内静脉的肠系膜上静脉-腔静脉分流术和54例门腔静脉侧侧分流术。从预防再出血、分流的通畅性、肝性脑病、康复及长期生存率等方面对患者进行了评估。所有患者均接受了随访观察。在部分选定患者中，术后进行了血管造影检查，并检测了血清章鱼胺水平。在肠系膜上静脉-腔静脉分流组中，分流通畅率为82%，肝性脑病发生率为35%，采用精算方法计算的长期生存率为65%。在门腔静脉分流组中，肝性脑病发生率为54%，生存率为38%。血清章鱼胺水平与肝性脑病之间无相关性。在肠系膜上静脉-腔静脉分流组中，分流通畅的患者经动脉造影证实95%的患者肝脏有持续灌注。就肝性脑病发生率和生存率而言，肠系膜上静脉-腔静脉分流术似乎是一种有效的技术，但需要进行随机研究以证明该技术比标准的门腔静脉分流术更有效。
