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Partial portacaval shunt with H-grafts to treat portal hypertension

XU Geliang, HU Hejie, LI Jiansheng, YANG Shugao, CHAI Zhongpei, XU Rongnan

《医学前沿（英文）》 2007年第1卷第3期页码 279-281 doi: 10.1007/s11684-007-0053-z

摘要： Partial portosystemic shunts have been popularized because of a reported low rate of mortality and morbidity (especially encephalopathy, liver failure and occlusion). The results of partial portacaval shunts [small-diameter expanded polytetrafluoroethylene (ePTFE) H-graft portacaval shunt] were retrospectively reviewed to evaluate the clinical efficacy in the treatment of portal hypertension. Forty-three patients with portal hypertension were treated by small-diameter H-graft of ePTFE portacaval shunt from May 1995 to April 2006. Thirty-three had externally ringed grafts and ten had non-ringed ones. Ten had grafts of 10 mm in diameter and 33 had grafts of 8 mm. The left gastric artery and coronary vein were ligated in all the cases. Six had pericardial devascularization and splenectomy was performed in 42. An average decrease of free portal pressure (FPP) from (33.24 ± 4.78) cmHO before shunting and (13.65 ± 5.65) cmHO after shunting was observed. The portal blood flow was reduced by one-third of that before shunt. Thirty-eight patients survived and no upper gastro-intestinal rebleeding occurred in the follow-up period (50.5 months in average). Two were out of contact. Color Doppler ultrasonography and/or portography revealed the shunts were patent in 38 cases and were occluded in three cases (3/41, 7.3%). Encephalopathy developed in five cases (5/41, 12.2%). Partial (small-diameter ePTFE H-graft) portacaval shunting can reduce the portal pressure effectively. Majority of the hepatic flow from the portal vein can be maintained adequately. The shunts with reinforced grafts can keep a higher rate of patency. The morbidity of encephalopathy was lower than those with total shunt. The partial portacaval shunt is effective in preventing recurrent variceal bleeding.

关键词： diameter clinical efficacy bleeding pericardial devascularization Forty-three

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Effects of combined procedure and devascularization alone on hyperdynamics of the portal venous system

HUA Rong, SUN Yongwei, WU Zhiyong

《医学前沿（英文）》 2008年第2卷第3期页码 244-247 doi: 10.1007/s11684-008-0046-6

摘要： Shunts and devascularizations have totally different effects on the hemodynamics of the portal venous system. The actual results of pericardial devascularization (PCDV) alone and conventional splenorenal shunt combined with pericardial devascularization (combined procedure, CP) should be determined by more clinical observations. This study aimed to evaluate effects on hemodynamics in the portal venous system after CP and PCDV only. In 20 patients who received CP and 18 who received PCDV, hemodynamic parameters of the portal venous system were studied by magnetic resonance angiography 1 week before and 2 weeks after operation. Free portal pressure (FPP) was continuously detected by a transducer during the operations. Compared to the preoperative data, a decreased flow in the portal vein (PVF) [(563.12 ± 206.42) mL/min (1080.63 ± 352.85) mL/min, < 0.05], a decreased portal vein diameter (PVD) [(1.20 ± 0.11) cm (1.30 ± 0.16) cm, < 0.01], a decreased FPP [(21.50 ± 2.67) mmHg (29.88 ± 2.30) mmHg, < 0.01] and an increased flow in the superior mesenteric vein (SMVF) [(1105.45 ± 309.03) mL/min (569.13 ± 178.46) mL/min, < 0.05] were found in the CP group after operation; a decreased PVD [(1.27 ± 0.16) cm (1.40 ± 0.23) cm, < 0.05], a decreased PVF [(684.60 ± 165.73) mL/min (1175.64 ± 415.09) mL/min, < 0.05], a decreased FPP [(24.40 ± 3.78) mmHg (28.80 ± 3.56) mmHg, < 0.05] and an increased SMVF [(697.91 ± 121.83) mL/min (521.30 ± 115.82) mL/min, < 0.05] were observed in the PCDV group. After operation, PVF in the CP group [(563.12 ± 206.42) mL/min (684.60 ± 165.73) mL/min, > 0.05] had no significant decrease, while FPP [(21.50 ± 2.67) mmHg (24.40 ± 3.78) mmHg, < 0.01] had a significant decrease as compared with that in the PCDV group. PVF and FPP could be decreased by both surgical procedures, but the effect of decreasing FPP was much better in the combined procedure than in PCDV alone. Further, there was no significant difference in PVF between the two groups. It is suggested that the combined surgical procedure could integrate the advantages of shunting with those of devascularization, as well as maintaining the normal anatomic structure of hepatic portal system, thus it should be one of the best choices for patients with portal hypertension when surgical interventions are considered.