Maksoud J G, Mies S
Ann Surg. 1982 Apr;195(4):401-5. doi: 10.1097/00000658-198204000-00004.
Twenty-one children from the ages of 4 to 12 years old were treated for esophageal hemorrhage by distal splenorenal shunt (DSS). In four patients, thrombosis of the shunt occurred within the first 24 hours after operation. In the other 17 children, long-term shunt patency was verified. Only one thrombosis has occurred in the last 15 consecutive cases. The patients were followed from one-half to six years. Late angiographic studies were performed in five patients. Forward flow through the portal vein was demonstrated in all patients. In addition, collateralization between the portomesenteric (PM) and gastrosplenic (GS) compartments was present in each case. In four patients with a wide-open shunt, the direction of collateral flow was from the PM to the GS compartment. In one child in whom the shunt was partially obstructed, the flow was from the GS to the PM compartment. In all 17 successful cases, esophageal variceal hemorrhage ceased, and there were no instances of hepatic encephalopathy. It is concluded that DSS is a safe and effective surgical procedure for the treatment of esophageal bleeding in children.
21名4至12岁的儿童接受了远端脾肾分流术（DSS）治疗食管出血。4例患者在术后24小时内发生分流血栓形成。在其他17名儿童中，分流长期通畅得到证实。在连续的最后15例病例中仅发生1例血栓形成。对患者进行了半年至6年的随访。5例患者进行了晚期血管造影研究。所有患者均显示门静脉有正向血流。此外，在每个病例中，门静脉肠系膜（PM）和胃脾（GS）腔之间均存在侧支循环。在4例分流完全开放的患者中，侧支血流方向是从PM到GS腔。在1例分流部分阻塞的儿童中，血流是从GS到PM腔。在所有17例成功病例中，食管静脉曲张出血停止，且无肝性脑病发生。结论是，DSS是治疗儿童食管出血的一种安全有效的外科手术。
