■近端脾肾分流术(PSRS)是一种常用的门脉高压减压手术,难治性静脉曲张出血患者,尤其是在非肝硬化门静脉高压症(NCPH)。如果传统方法受到任何技术或病理因素的阻碍,可能需要替代手术技术。这项研究分析了对NCPH进行的各种非常规分流手术的有效性。
■对2011年7月至2022年6月期间接受非常规分流手术的NCPH患者进行了回顾性分析。所有患者均随访至少12个月,并对分流进行多普勒研究以评估分流通畅性。和上消化道内镜检查以评估静脉曲张的消退。
■在研究期间,130名患者接受了分流手术;其中,31例接受了非常规分流术(脾肾上腺分流术[SAS],12;介入中腔分流[iMCS],8;插入PSRS[iPRS],6;空肠静脉-静脉分流术[JCS],3;左胃-肾分流术[LGERS],2).非常规分流的主要指征是左肾静脉畸变(SAS,8/12),脾静脉狭窄(iMCS,5/8),门部高血压血管变化(iPSRS,6/6),和肠道血栓形成(JCS,3/3)。SAS中门静脉压力的中值下降更多(12.1mmHg),JCS的手术时间更多,8.4小时(范围,5-9小时)。在36个月(6-54个月)的中位随访期间,在所有LGERS病例中都报告了分流血栓形成,SAS(3/12)较少。SAS的静脉曲张回归率很高,至少在LGERS所有患者的脾功能亢进都逆转了,6/31的患者有复发性出血。
■非常规分流手术对不适合其他分流的患者有效,尤其是PSRS,在相当比例的患者中达到了预期的效果。
UNASSIGNED: Proximal splenorenal shunt (PSRS) is a commonly performed procedure to decompress portal hypertension, in patients with refractory variceal bleed, especially in non-cirrhotic portal hypertension (NCPH). If conventional methods are hindered by any technical or pathological factors, alternative surgical techniques may be required. This study analyzes the effectiveness of various unconventional shunt surgeries performed for NCPH.
UNASSIGNED: A retrospective analysis of NCPH patients who underwent unconventional shunt surgeries during the period July 2011 to June 2022 was conducted. All patients were followed up for a minimum of 12 months with doppler study of the shunt to assess shunt patency, and upper gastrointestinal endoscopy to evaluate the regression of varices.
UNASSIGNED: During the study period, 130 patients underwent shunt surgery; among these, 31 underwent unconventional shunts (splenoadrenal shunt [SAS], 12; interposition mesocaval shunt [iMCS], 8; interposition PSRS [iPSRS], 6; jejunal vein-cava shunt [JCS], 3; left gastroepiploic-renal shunt [LGERS], 2). The main indications for unconventional shunts were left renal vein aberration (SAS, 8/12), splenic vein narrowing (iMCS, 5/8), portalhypertensive vascular changes (iPSRS, 6/6), and portomesenteric thrombosis (JCS, 3/3). The median fall in portal pressure was more in SAS (12.1 mm Hg), and operative time more in JCS, 8.4 hours (range, 5-9 hours). During a median follow-up of 36 months (6-54 months), shunt thrombosis had been reported in all cases of LGERS, and less in SAS (3/12). Variceal regression rate was high in SAS, and least in LGERS. Hypersplenism had reversed in all patients, and 6/31 patients had a recurrent bleed.
UNASSIGNED: Unconventional shunt surgery is effective in patients unsuited for other shunts, especially PSRS, and it achieves the desired effects in a significant proportion of patients.