Angel Mercado M, Granados-García J, Barradas F, Chan C, Contreras J L, Orozco H
Clínica de hipertensión portal, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F.
Gac Med Mex. 1998 Mar-Apr;134(2):135-43; discussion 143-4.
Low diameter porto-systemic shunts for the treatment of portal hypertension bleeding have emerged as a consequence of the technical development of vascular grafts (PTFE) that allow the use of a narrow lumen. The experience with this kind of operation at the Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City during a 6-year period is reported. There were twenty-seven patients with good liver function (Child-Pugh A-B) were operated or electively, average Age 47.5 years (range 17-71), twenty three patients with liver cirrhosis, one with portal fibrosis and three with idiopathic portal hypertension. Operative mortality: 4%. Rebleeding: 14%. Postoperative encephalopathy was observed in 14 of 27, three of them being grade III-IV (11%). In the remaining 11 cases, it was mild and easily controlled. Postoperative angiography showed shunt patency in 81% of the cases; in 33% of the cases, portal vein diameter reduction was shown, as well as two cases with portal vein thrombosis. In 77% of the cases, adequate postoperative quality of life was observed. Survival (Kaplan-Meier): 86% at 12 months and 56% at 60 months. These kinds of shunts are a good alternate choice for patients considered for surgery, in which other portal blood flow preserving procedures (selective shunts, devascularization with transection) are not feasible.
由于血管移植物（聚四氟乙烯）技术的发展使得可以使用窄内腔，用于治疗门静脉高压出血的小直径门体分流术应运而生。本文报告了墨西哥城国家营养研究所萨尔瓦多·苏比拉án分院在6年期间开展此类手术的经验。共有27例肝功能良好（Child-Pugh A-B级）的患者接受了手术或择期手术，平均年龄47.5岁（范围17-71岁），其中23例为肝硬化患者，1例为门静脉纤维化患者，3例为特发性门静脉高压患者。手术死亡率为4%。再出血率为14%。27例患者中有14例出现术后脑病，其中3例为III-IV级（11%）。其余11例症状较轻，易于控制。术后血管造影显示81%的病例分流通畅；33%的病例显示门静脉直径减小，还有2例出现门静脉血栓形成。77%的病例术后生活质量良好。生存率（Kaplan-Meier法）：12个月时为86%，60个月时为56%。对于考虑手术但其他保留门静脉血流的手术（选择性分流、横断去血管化）不可行的患者，这类分流术是一个很好的替代选择。
