OBJECTIVE The purpose of this study was to study the effect of splenopneumopexy for patients with portal hypertension in children. METHODS From March 1993 to April 1998, splenopneumopexy was performed on six children with portal hypertension. Doppler ultrasound and radionuclide were used to demonstrate the portopulmonary shunt after operation. RESULTS The bleeding from the esophageal varices was controlled and the esophageal varices were eliminated gradually. The symptoms pertaining to hypertension were disappeared. The patency of the shunt was maintained without the formation of thrombosis. No pulmonary complication was observed. CONCLUSION The results indicated that splenopneumopexy was a safe and effective procedure for patients with portal hypertension in children.
目的 探讨门静脉高压症手术适应证、手术时机和术式选择。 方法 回顾性分析我院56例门静脉高压症手术治疗患者的资料。 结果 行预防性手术治疗12例，无死亡； 行治疗性手术44例，死亡16例（36.4%）。择期手术38例中死亡2例（5.3%），急诊手术18例中死亡14例（77.8%）。行断流术40例； 死亡16例（40.0%）； 行断流加分流术16例，无死亡。 结论 门静脉高压症并发巨脾，严重脾功能亢进，重度食管静脉曲张且镜下见有出血倾向，肝功Child A、B级者可行预防性手术； 对治疗性手术应尽早施行或择期施行； 急诊手术以贲门周围血管离断术为首选，择期手术以分流加断流术为宜。
目的探讨肝外型门静脉高压症的外科治疗经验。方法1993年1月至1999年12月，我科收治肝外型门静脉高压症42例，男19例，女23例，年龄8~58岁，平均24.6岁，经B超、动脉造影、脾静脉造影和术中探查，诊断为门静脉血栓形成34例，内脏动静脉瘘5例，终末支门静脉纤维化2例，肝动脉瘤压迫门静脉1例。根据病变不同，分别给予肠腔分流、脾肾分流、经导管溶栓及栓塞或动静脉瘘切除等治疗。结果术后2例死亡，并发肝脓肿1例，肠坏死1例，其余患者均获满意疗效。有31例随访5个月~6年无复发。结论肝外型门静脉高压症只要选择好合理的治疗方法，可获满意疗效，且远期效果良好。
在以往的时日里，对于肝硬变门静脉高压症的治疗常常争论于是以内科治疗为主还是外科治疗为主; 若进行外科治疗，是以断流还是分流手术为首选，抑或联合手术； 若选定了某种术式，是行预防性干预还是不得已而为之的急诊干预，凡此种种，尚可举之。但是时至今日，该领域在观念和技术上已经有了很大的变革与进步。对此，我们的关注及思考也随之发生变化，现不揣冒昧，敞开所想，予以探讨……
目的探讨防止限制性门腔静脉侧侧分流术后吻合口扩大的方法。方法对32例肝硬变门脉高压症患者行限制性门腔静脉分流术，术中采用不吸收缝线连续缝合门腔静脉吻合口前后壁形成自然的限制环，以防止术后吻合口的扩大。结果32例患者于术后3～36个月行彩超或螺旋CT检查，显示门腔静脉吻合口均无扩大； 术后再出血率为3.1%（1/32），肝性脑病发生率为6.3%（2/32）； 术后≤6个月时肝功能均有不同程度改善，与术前比较其差异有显著性（P＜0.001）； 全部病例随访6~49个月，随访率为100%。结论改良的限制性门腔静脉侧侧分流术是治疗肝硬变门脉高压症的有效方法。
Surgerical treatment has been used for portal hypertension over a hundred years, and has evolved from various portosystemic shunts to devascularizations and selective shunts. Selective shunting, which has the advantages of long-term prevention from recurrent variceal bleeding and maintenance of hepatic portal vein perfusion, has developed from single distal splenorenal shunt to various procedures including distal splenocaval shunt, coronary caval shunt, coronary renal shunt, etc. Selective shunting can also be achieved after reconstruction of spontaneous portosystemic shunt. Preoperative portal venous system CT angiography, intraoperative ultrasound Doppler and portal vein pressure measurements may provide patients with a more reasonable treatment of choice.
Objective To explore the methods， clinical effects， and application value of laparoscopic splenectomy combined with pericardial devascularization. Methods The clinical data of 23 patients with liver cirrhosis and portal hypertension who performed laparoscopic splenectomy combined with pericardial devascularization between july 2009 and july 2012 in our hospital were analyzed retrospectivly. Results In 23 cases， 2 cases were converted laparotomy due to bleeding， 21 cases were successfully performed laparoscopic splenectomy combined with pericardial devascularization. The operative time was 230-380 minutes （average 290 minutes）. The intraoperative blood loss was 300-1 500 mL （average 620 mL）. The postoperative fasting time was 1-3 days （average 2 days）. The postoperative hospital stay was 8-14 days （average 10 days）. Conclusion Laparoscopic splenectomy combined with pericardial devascularization is a feasible， effective， and safe procedure as well as minimally invasive hence is applicable for patients with portal hypertension and hypersplenism．