Valayer J
Chir Pediatr. 1982 May-Jun;23(3):214-7.
The choice of a surgical procedure for correction of portal hypertension in children should be guided by the site of the blockage on portal circulation, its anatomic and hemodynamic conditions, and also by the experience of the surgical team. At the present time, in our series, distal splenorenal shunt, or meso caval shunt with jugular vein interposition are preferred to the more usual ones, such as the central splenorenal shunt with splenectomy or mesocaval shunt with iliac vein. Thus an extrahepatic block would be treated by an interposition shunt, or a distal splenorenal shunt if the splenic vein is of a proper diameter; an intrahepatic block would be treated by a Warren shunt, even though some of the latest publications on the subject underline the fact that the disconnection part of the operation does not last with time; in the case of a suprahepatic block, a mesocaval shunt with interposition could be constructed provided the pressure in the lower vena cava is not too elevated; the same operation could be planed for difficult situations such as failures of a previous shunt or extensive thrombosis of the portal vein and tributaries. As for direct action on esophageal varices, every one agrees about the poor quality of results in the case of simple ligation; however the experience with more extensive operations such as Sugiura's procedure, and also that of endoscopic sclerosis or embolization in children are yet short and limited.
儿童门静脉高压症手术矫正方法的选择，应以门静脉循环阻塞部位、其解剖和血流动力学状况以及手术团队的经验为指导。目前，在我们的系列病例中，远端脾肾分流术或带颈静脉间置的肠系膜上腔静脉分流术比更常用的术式，如脾切除的中央脾肾分流术或带髂静脉的肠系膜上腔静脉分流术更受青睐。因此，肝外阻塞可采用间置分流术治疗，若脾静脉直径合适，也可采用远端脾肾分流术；肝内阻塞可采用沃伦分流术治疗，尽管关于该主题的一些最新出版物强调手术的离断部分不会随时间持续有效这一事实；对于肝上阻塞，若下腔静脉压力不过高，可构建带间置的肠系膜上腔静脉分流术；对于诸如既往分流失败或门静脉及其分支广泛血栓形成等困难情况，也可计划实施相同手术。至于对食管静脉曲张的直接处理，大家都认同单纯结扎效果不佳；然而，诸如杉浦手术等更广泛手术以及儿童内镜硬化或栓塞术的经验尚少且有限。
