Britton R C
Am J Surg. 1977 Apr;133(4):506-11. doi: 10.1016/0002-9610(77)90140-4.
The use of four types of selective portal shunts designed to avoid postshunt encephalopathy has been reviewed. The incidence of hospital mortality and recurrent hemorrhage from varices among 187 reported cases have been comparable to standard portacaval shunts. The incidence of postshunt encephalopathy among 154 survivors with patent shunts followed from two to ninety-six months has averaged 8 per cent but with significant differences between the types of operation. The most effective has been the left gastric vein to vena cava shunt followed by the distal splenorenal shunt, the modified central splenorenal shunt, and the central splenorenal shunt, with success in avoiding encephalopathy in direct proportion to the number and size of postoperative collaterals between the persistently hypertensive portal system and the decompressed splenic system. The development of such collaterals inlong-term survivors, especially after the splenorenal shunts, may contribute to an incidence of late encephalopathy approaching that of nonoperative patients.
对旨在避免分流术后肝性脑病的四种类型的选择性门体分流术的应用进行了回顾。在187例报告病例中，医院死亡率和静脉曲张再出血的发生率与标准门腔分流术相当。对154例分流术通畅的幸存者进行了随访，随访时间为2至96个月，分流术后肝性脑病的发生率平均为8%，但不同手术类型之间存在显著差异。最有效的是胃左静脉至腔静脉分流术，其次是远端脾肾分流术、改良的中央脾肾分流术和中央脾肾分流术，避免肝性脑病的成功率与持续高血压门静脉系统和减压脾系统之间术后侧支循环的数量和大小成正比。在长期存活者中，尤其是脾肾分流术后，这种侧支循环的形成可能导致晚期肝性脑病的发生率接近非手术患者。
