Bismuth H, Franco D, Alagille D
Ann Surg. 1980 Jul;192(1):18-24. doi: 10.1097/00000658-198007000-00003.
Ninety children with portal hypertension were treated by portal diversion. Fifty-two had cavernous transformation of the portal vein and 38 had an intrahepatic block from various causes. There were 59 central splenorenal shunts, 19 mesocaval, 11 portacaval and one distal splenorenal. In 61 peripheral shunts the veins used for the anastomosis were less than 10 mm in diameter. There was no operative mortality in children with extrahepatic block. One child with cystic fibrosis died postoperatively. Thrombosis of the shunt occurred in five children (5.6 per cent) and was responsible for recurrent bleeding in two. Four children with a thrombosed shunt underwent succesful reoperation and one is awaiting another anastomosis. No late complications occurred in the 52 children with extrahepatic block, while encephalopathy developed in four children with intrahepatic block. These figures confirm our earlier results in the management of portal hypertension in childhood and suggest that portal diversion is the treatment of choice. Several precautions have permitted lowering of the rate of thrombosis whichever shunt is performed. Portal diversion should be indicated following the first episode of hemorrhage in children with extrahepatic block. In patients with intrahepatic block, congenital hepatic fibrosis and cystic fibrosis are good indications as are in general the hepatic diseases with no or mild activity.
90例门静脉高压患儿接受了门体分流术治疗。其中52例存在门静脉海绵样变性，38例因各种原因导致肝内阻塞。共进行了59例中央脾肾分流术、19例肠系膜上腔静脉分流术、11例门腔静脉分流术和1例远端脾肾分流术。在61例外周分流术中，用于吻合的静脉直径小于10毫米。肝外阻塞患儿无手术死亡病例。1例患有囊性纤维化的患儿术后死亡。5例患儿（5.6%）发生分流血栓形成，其中2例因分流血栓形成导致反复出血。4例分流血栓形成的患儿再次手术成功，1例正在等待再次吻合。52例肝外阻塞患儿未发生晚期并发症，而4例肝内阻塞患儿发生了肝性脑病。这些数据证实了我们早期在儿童门静脉高压治疗中的结果，并表明门体分流术是首选治疗方法。无论进行何种分流术，采取的一些预防措施已使血栓形成率降低。肝外阻塞患儿首次出血后应行门体分流术。对于肝内阻塞患儿、先天性肝纤维化和囊性纤维化患儿，一般而言，无活动或活动轻微的肝脏疾病都是门体分流术的良好适应证。
