Arterialization of the Portal Vein in Conjunction with a Therapeutic Portacaval Shunt Hemodynamic Investigations and Results in 75 Patients
Arterialization of the Portal Vein in Conjunction with a Therapeutic Portacaval Shunt Hemodynamic Investigations and Results in 75 Patients
复制标题
门静脉动脉化联合治疗性门静脉分流术 75 名患者的血流动力学研究和结果
DOI：
10.1097/00000658-198212001-00007
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发表时间：
1982
影响因子：
9
通讯作者：
P. Kestens
中科院分区：
文献类型：
--
作者：
J. Otte;B. Hemptinne;A. Geubel;M. Carlier;J. Jamart;L. Lambotte;P. Kestens
75例心脏病患者接受了包括流量和压力研究在内的围手术期血流动力学检查。62例肝门脉血流患者接受了治疗性端侧门腔分流术（PC）联合门静脉动脉化，13例血流停滞患者单独接受了PC分流术。急诊手术35例，择期手术40例。61例门静脉血流量与最大灌注压相关（r = 0.66），33例门静脉阻塞引起的校正窦压降低相关（r = 0.72）。57例A、B级患者的手术死亡率为3.5%，18例C级患者的手术死亡率为55.5%，动脉化患者（14.8%）和非动脉化患者（62.5%）的急诊手术死亡率存在显著差异（p < 0.05）。在1981年7月15日这项研究结束时，所有患者的随访时间都超过了两年。全组动脉化患者的5年生存率为48%，A级和B级患者的5年生存率为56%;慢性脑病的总发生率为20%。结论：动脉化是一种安全的外科手术，在急诊手术死亡率、晚期生存率和耐受门腔静脉分流方面可能是有益的。然而，1979年12月进行的前瞻性随机研究是唯一明确证明动脉化确实能够最大限度地减少脑病风险并延长门腔静脉分流术后长期生存的方法。
Seventy-five cirrhotic patients were submitted to peroperative hemodynamic investigations including flow and pressure studies. Sixty-two patients with a hepatopedal portal flow underwent a therapeutic end-to-side portacaval shunt (PC) in conjunction with arterialization of the portal vein and 13 with a stagnant flow a PC shunt alone. Thirty-five patients were operated on in emergency and 40 electively. In 61 patients portal flow was correlated with maximum perfusion pressure (r = 0.66), and in 33 patients with the reduction of corrected sinusoidal pressure induced by the occlusion of the portal vein (r = 0.72). Operative mortality, which was 3.5% for 57 class A and B patients and 55.5% for 18 class C patients, differed significantly (p < 0.05) in emergency between arterialized (14.8%) and nonarterialized patients (62.5%). At the time this study was ended on July 15, 1981, the follow-up was over two years for all the patients. The five-year actuarial survival rate of the arterialized patients was 48% for the whole group and 56% for class A and B patients; the overall incidence of chronic encephalopathy was 20%. It is concluded that arterialization is a safe surgical procedure that could be beneficial in respect with operative mortality in emergency, late survival, and toierance to portacaval shunt. However, a prospective randomized study such as the one undertaken in December 1979 is the only method to prove clearly that arterialization is really able to minimize the risk of encephalopathy and to prolong the long-term survival after portacaval shunt.