Henderson J M
Cleveland Clinic Foundation, Ohio.
Adv Surg. 1993;26:233-57.
Surgical shunts in the management of portal hypertension are one component of overall management. The main complications of portal hypertension is variceal bleeding. The very high mortality rate of this complication mandates careful assessment and appropriate treatment. Despite the introduction of new treatment methods such as pharmacologic reduction of portal pressure and endoscopic sclerotherapy, taken in conjunction with the coming of age of liver transplantation, surgical decompressive shunts still have a role in the overall treatment of these patients. The choice of therapy is based on full evaluation. The emphasis of that evaluation is on hepatic function. The patients who can live with their liver for an acceptable period of time and do not have the bleeding controlled with lesser medical managements require decompressive shunts. Surgical decompression of portal hypertension may also be required in the patient who is bleeding to death in the acute setting and, finally, is required for the treatment of acute Budd-Chiari syndrome. The choice of shunt procedures should take into account the potential for liver transplantation at some point in the future.
手术分流术在门静脉高压症的治疗中是整体治疗的一个组成部分。门静脉高压症的主要并发症是静脉曲张出血。这种并发症的极高死亡率要求进行仔细评估并采取适当治疗。尽管引入了新的治疗方法，如药物降低门静脉压力和内镜硬化治疗，再加上肝移植技术的成熟，但手术减压分流术在这些患者的整体治疗中仍有作用。治疗方法的选择基于全面评估。该评估的重点是肝功能。那些能够在可接受的时间内依靠自身肝脏生存且出血无法通过较少的药物治疗得到控制的患者需要进行减压分流术。对于在急性情况下因出血而濒死的患者，也可能需要进行门静脉高压症的手术减压，最后，急性布加综合征的治疗也需要手术减压。分流手术的选择应考虑到未来某个时间点进行肝移植的可能性。
