Guharay B N, Sain P, Banerjee D, Guha Majumdar D N, Sengupta K P, Basu A K
Surgery. 1980 Mar;87(3):271-9.
A new operation for selective decompression of portal hypertension in children with diminutive splenic veins is desired. The operation, direct splenocaval shunt (S-D-SCS), produces transplenic decompression of gastric-esophageal varices without interfering with the existing portal flow status in any significant measure. The proximal free end of the inferior vena cava (IVC) is joined to the side of the splenic vein, which is ligated on the hepatic side of the anastomosis. Addition of partial gastric devascularization completes the operation. Technically the operation is simple and easily executable. Because the IVC is utilized in creation of the shunt, anastomoses as large as 1.72 +/- 0.45 cm in diameter are obtained with splenic veins of less than 1 cm in diameter. S-D-SCS was performed in 10 children with a mean age of 9.25 +/- 3.36 years and a mean splenic vein size of 8.2 +/- 2.25 mm in diameter. Shunt thrombosis occurred in one patient who died. Nine patients survived the operation and obtained class A surgical results over a follow-up period of 7 to 12 months. None rebled, developed postshunt encephalopathy (PSE), or manifested laboratory evidences of protein intolerance. Insignificant alterations were brought about in liver blood flow (EHBF) and sinusoidal pressure (CSP); portal blood flow to the liver was maintained; and liver function tests were preserved at preoperative levels. The surgical results were superior to those following mesentericocaval and portacaval shunts in our earlier series of children with comparable mean age, body weight, and postoperative interval when studied functionally. About 30% of all of the shunt patients died of liver failure within weeks or months after the operations, and an additional 30% of the patients developed clinically significant PSE over variable periods of follow-up. These high mortality and morbidity rates were preceded by significant reductions in EHBF and CSP and concomitant precipitation of liver function abnormalities.
对于脾静脉细小的儿童门静脉高压症，需要一种新的选择性减压手术。该手术，即直接脾腔分流术（S-D-SCS），可在不显著干扰现有门静脉血流状态的情况下，通过脾进行胃食管静脉曲张减压。下腔静脉（IVC）的近端游离端与脾静脉的侧面相连，脾静脉在吻合口的肝侧进行结扎。加上部分胃去血管化，手术即完成。从技术上讲，该手术简单且易于实施。由于在分流术创建中使用了IVC，对于直径小于1cm的脾静脉，可获得直径达1.72±0.45cm的吻合口。对10名平均年龄为9.25±3.36岁、平均脾静脉直径为8.2±2.25mm的儿童实施了S-D-SCS。一名患者发生分流血栓形成并死亡。9名患者术后存活，在7至12个月的随访期内获得了A级手术效果。无再出血、发生分流后脑病（PSE）或出现蛋白质不耐受的实验室证据。肝血流（EHBF）和肝窦压力（CSP）无显著改变；维持了流向肝脏的门静脉血流；肝功能检查保持在术前水平。在对具有可比平均年龄、体重和术后间隔时间的儿童进行功能研究时，该手术的结果优于我们早期系列中肠系膜上腔静脉分流术和门腔静脉分流术的结果。在所有分流术患者中，约30%在术后数周或数月内死于肝功能衰竭，另外30%的患者在不同的随访期内出现了具有临床意义的PSE。这些高死亡率和发病率之前，EHBF和CSP显著降低，并伴有肝功能异常的发生。
