Reiner D S, Kaminski D L
Am J Surg. 1982 Dec;144(6):704-10. doi: 10.1016/0002-9610(82)90555-4.
There is currently available a variety of operative techniques that, by shunting of portal blood into the systemic circulation, decompress esophagogastric varices. Continued evaluation of when to employ a specific type of portosystemic shunt is indicated. This report compares experience with nonselective peripheral portosystemic shunts with selective distal splenorenal shunts. Twenty-nine patients were divided into two operative groups. All patients were operated on for variceal hemorrhage. The two patient groups were similar preoperatively in all parameters evaluated except that the patients having nonselective peripheral shunts had more ascites and four were operated on for acutely bleeding varices, whereas the selective shunt patients had minimal ascites and non were operated on for acute bleeding. Rebleeding rates, incidence of encephalopathy, and long-term survival were not significantly different between the two groups. Eight of 14 (57 percent) patients discharged from the hospital with selective distal splenorenal shunts were alive with a mean follow-up interval of 19 months. Eight of 11 (72 percent) patients discharged with nonselective peripheral shunts were alive with a mean follow-up interval of 34 months. These results suggest that if technical or clinical conditions preclude the performance of a selective distal splenorenal shunt, a nonselective peripheral shunt will produce comparable results and can be used with confidence.
目前有多种手术技术，通过将门静脉血分流至体循环，可使食管胃静脉曲张减压。需要持续评估何时采用特定类型的门体分流术。本报告比较了非选择性外周门体分流术与选择性远端脾肾分流术的经验。29例患者被分为两个手术组。所有患者均因静脉曲张出血接受手术。两个患者组在术前评估的所有参数上相似，但接受非选择性外周分流术的患者腹水较多，4例因急性出血性静脉曲张接受手术，而选择性分流术患者腹水极少，无一人因急性出血接受手术。两组之间的再出血率、脑病发生率和长期生存率无显著差异。接受选择性远端脾肾分流术出院的14例患者中有8例（57%）存活，平均随访间隔为19个月。接受非选择性外周分流术出院的11例患者中有8例（72%）存活，平均随访间隔为34个月。这些结果表明，如果技术或临床条件不允许进行选择性远端脾肾分流术，非选择性外周分流术将产生类似的结果，可放心使用。
