Sharma B C, Singh R P, Chawla Y K, Narasimhan K L, Rao K L, Mitra S K, Dilawari J B
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Gastroenterol Hepatol. 1997 Aug;12(8):582-4. doi: 10.1111/j.1440-1746.1997.tb00489.x.
Shunt surgery is considered to be the treatment of choice in patients with non-cirrhotic portal hypertension. There is little data on the effect of side-to-side lieno-renal (SSLR) shunt on oesophageal variceal size, splenic size and splenic pulp pressure (SPP) in patents with non-cirrhotic portal hypertension. We evaluated pre- and postoperatively endoscopic grading of varices, splenic size and SPP for predicting shunt patency in 86 patients with non-cirrhotic portal hypertension: 56 with extrahepatic portal venous obstruction (EHPVO) and 30 with non-cirrhotic portal fibrosis (NCPF). The EHPVO patients with patent shunts (n = 47) showed significant reduction in SPP (pre-operative 43.56 +/- 7.9 vs postoperative 29.96 +/- 0.5 vs 0.92 +/- 0.8). Patients with blocked shunt (n = 9) did not show significant reduction in SPP and varices grades. However, there was reduction in spleen size (8.6 +/- 3.0 vs 6.3 +/- 4.3). In the NCPF group, 28 had patent shunts and showed significant reduction in SPP (46.3 +/- 13.5 vs 33.8 +/- 7.6 cm of saline), splenic size (9.1 +/- 3.3 vs 6.8 +/- 4.6 cm below costal margin) and varices grades (2.8 +/- 0.7 vs 1.05 +/- 0.96). As only two patients with NCPF had blocked shunts, no statistical comparison between patients with patent and patients with blocked shunts could be done. In conclusion, following SSLR, there is a significant reduction in SPP and varices grades in patients with patent shunts. Endoscopic grading of varices can be used to predict shunt patency. However, spleen size is not a good criteria for predicting shunt patency.
分流手术被认为是治疗非肝硬化门静脉高压症患者的首选方法。关于侧侧脾肾分流术（SSLR）对非肝硬化门静脉高压症患者食管静脉曲张大小、脾脏大小和脾髓压（SPP）影响的数据很少。我们评估了86例非肝硬化门静脉高压症患者术前和术后的静脉曲张内镜分级、脾脏大小和SPP，以预测分流的通畅情况：56例为肝外门静脉阻塞（EHPVO）患者，30例为非肝硬化门静脉纤维化（NCPF）患者。分流通畅的EHPVO患者（n = 47）的SPP显著降低（术前43.56±7.9，术后29.96±0.5，对比0.92±0.8）。分流阻塞的患者（n = 9）的SPP和静脉曲张分级没有显著降低。然而，脾脏大小有所减小（8.6±3.0对比6.3±4.3）。在NCPF组中，28例分流通畅，其SPP（46.3±13.5对比33.8±7.6 cm盐水柱）、脾脏大小（肋缘下9.1±3.3对比6.8±4.6 cm）和静脉曲张分级（2.8±0.7对比1.05±0.96）均显著降低。由于只有2例NCPF患者分流阻塞，因此无法对分流通畅和阻塞的患者进行统计学比较。总之，SSLR术后，分流通畅的患者SPP和静脉曲张分级显著降低。静脉曲张内镜分级可用于预测分流通畅情况。然而，脾脏大小不是预测分流通畅情况的良好指标。
