Vollmar J, Loeprecht H, Ditschuneit H, Belohlavek D
Chirurg. 1978 Jul;49(7):414-8.
As a result of several retrospective and prospective studies, there have been remarkable changes in surgery for portal hypertension, namely the limitation of surgical interventions to an asymptomatic time interval (without bleeding), and the preference for distal shunt operations, aiming at a lasting reduction of the portal hypertension with minimal reduction of portal liver perfusion. These requirements are best met by the mesocaval (H-) shunt, using a vascular prosthesis with sufficient wall stability and a negatively charged inner surface, such as, for example, the expanded PTFE graft (Gore-TEX). In contrast to several types of splenorenal shunt, the H-shunt in mesocaval position is characterized by the following advantages: (a) minimal operative stress, even in high-risk patients, (b) technical ease of use, (c) reduced operative mortality, especially for interval operations, (d) minimal risk of recurrent bleeding and encephalopathy. From this preliminary report it may be expected that the technique of mesocaval expanded PTFE shunt here presented is likely to become the method of choice in both elective and emergency interventions.
经过多项回顾性和前瞻性研究，门静脉高压症的手术治疗发生了显著变化，即手术干预局限于无症状期（无出血），并且更倾向于远端分流手术，目的是在尽量减少门静脉肝灌注减少的情况下持久降低门静脉高压。使用具有足够壁稳定性和带负电荷内表面的血管假体，如膨体聚四氟乙烯移植物（戈尔泰克斯）的肠系膜上腔静脉（H型）分流术最能满足这些要求。与几种脾肾分流术不同，肠系膜上腔静脉位置的H型分流术具有以下优点：（a）手术应激最小，即使是高危患者；（b）技术操作简便；（c）手术死亡率降低，尤其是对于择期手术；（d）复发性出血和脑病风险最小。从这份初步报告可以预期，本文介绍的肠系膜上腔静脉膨体聚四氟乙烯分流术技术可能会成为择期和急诊干预的首选方法。
