PDF(Pubmed)
Abstract：
The main objective was to conduct a prospective study reporting the outcome for dogs with an extrahepatic congenital portosystemic shunt (CPSS) treated with a \'complete ligation where possible\' philosophy. The second aim was to compare the outcomes following complete (C) polypropylene suture ligation versus partial thin film band (TFB) attenuation of a CPSS in dogs. Dogs that could not tolerate acute complete shunt ligation at surgery received partial shunt attenuation with TFB. Peri-operative complications, mortality, follow-up imaging findings, pre- and post-operative bile acid stimulation test results and details of any revision surgery performed were recorded. A follow-up health-related quality of life questionnaire enabled the calculation of a postoperative clinical shunt score, a quality of life score, and determined if any dogs were still on a hepatic diet and/or other medical management at a minimum of 6 months after surgery. Of the 110 dogs enrolled, 57 received complete ligation and 53 received partial TFB attenuation. Peri-operative mortality, the occurrence of post-attenuation neurological complications, the occurrence of multiple acquired shunts, the postoperative clinical shunt score and quality of life score were not significantly different between the two groups. Dogs in the C group were older, heavier and demonstrated a greater number of shunt classifications where the entry into the systemic circulation was the phrenic vein or azygous vein. Dogs in the TFB group had a greater number of unchanged bile acid concentrations after surgery, were more likely to remain on the hepatic diet and/or medical management after surgery and underwent a greater number of revision surgeries. There was variability in the precision of both ultrasound and computed tomographic angiography follow-up imaging compared to intra-operative mesenteric portovenography findings at revision surgery. Overall, dogs with an extrahepatic portosystemic shunt receiving either complete acute shunt ligation or partial TFB shunt attenuation are expected to have an excellent long-term clinical outcome and there is no reason to suggest that a dog able to tolerate complete acute shunt closure should be denied the benefit of this.
摘要：
主要目的是进行一项前瞻性研究，报告对患有肝外先天性门体分流术（CPSS）的狗进行“尽可能完全结扎”治疗的结果。第二个目的是比较狗中CPSS的完全（C）聚丙烯缝合线结扎与部分薄膜带（TFB）衰减后的结果。在手术中不能耐受急性完全分流结扎的狗接受了TFB的部分分流衰减。围手术期并发症,死亡率,后续影像学发现，记录术前和术后胆汁酸刺激测试结果以及进行的任何翻修手术的详细信息。随访健康相关的生活质量问卷能够计算术后临床分流评分，生活质量评分，并确定是否有任何狗在手术后至少6个月仍在肝脏饮食和/或其他医疗管理。在110只狗中，57接受完全连接,53接受部分TFB衰减。围手术期死亡率,衰减后神经系统并发症的发生，发生多个获得性分流，两组患者术后临床分流评分和生活质量评分差异无统计学意义。C组的狗年龄较大，更重，并显示出更多的分流分类，其中进入体循环的是膈静脉或奇静脉。TFB组的狗在手术后有更多的胆汁酸浓度不变，更有可能在手术后保持肝脏饮食和/或医疗管理，并接受了更多的翻修手术。与翻修手术时的术中肠系膜门静脉造影结果相比，超声和计算机断层扫描血管造影随访成像的精度存在差异。总的来说,接受完全急性分流结扎或部分TFB分流减弱的肝外门体分流的犬预计具有优异的长期临床结果,并且没有理由认为能够耐受完全急性分流闭合的犬应该被拒绝获益。
