Paquet K J, Lazar A, Koussouris P, Hotzel B, Gad H A, Kuhn R, Kalk J F
Department of Surgery, Heinz Kalk Hospital, Bad Kissingen, Germany.
Br J Surg. 1995 Feb;82(2):199-203. doi: 10.1002/bjs.1800820219.
Fifty-seven patients with failed sclerotherapy received a mesocaval interposition shunt with an externally supported, ringed polytetrafluoroethylene prosthesis of either 10 or 12 mm diameter. Thirty-one patients had Child-Pugh grade A disease and 26 grade B; all had a liver volume of 1000-2500 ml. Follow-up ranged from 16 months to 6 years 3 months. Three patients (5 per cent) died in the postoperative period. There were two postoperative recurrences of variceal haemorrhage and one recurrent bleed in the second year after surgery. The cumulative shunt patency rate was 95 per cent and the incidence of encephalopathy 9 per cent; the latter was successfully managed by protein restriction and/or lactulose therapy. The actuarial survival rate for the whole group at 6 years was 78 per cent, for those with Child-Pugh grade A 88 per cent and for grade B 67 per cent. Small-lumen mesocaval interposition shunting achieves portal decompression, preserves hepatopetal flow, has a low incidence of shunt thrombosis, prevents recurrent variceal bleeding and is not associated with significant postoperative encephalopathy.
57例硬化治疗失败的患者接受了中腔静脉间置分流术，使用的是外部支撑的、直径为10或12毫米的带环聚四氟乙烯假体。31例患者为Child-Pugh A级疾病，26例为B级；所有患者的肝脏体积为1000 - 2500毫升。随访时间为16个月至6年3个月。3例患者（5%）在术后死亡。术后有2例静脉曲张出血复发，1例在术后第二年再次出血。分流的累积通畅率为95%，脑病发生率为9%；后者通过蛋白质限制和/或乳果糖治疗成功控制。全组6年的精算生存率为78%，Child-Pugh A级患者为88%，B级患者为67%。小口径中腔静脉间置分流术可实现门静脉减压，保留向肝血流，分流血栓形成发生率低，可预防静脉曲张出血复发，且与显著的术后脑病无关。
