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Surgical treatment of portal hypertension shunt and methods can be divided into two major categories of devascularization.
(1) bypass surgery can be divided into the following categories:
1) All portosystemic shunt the past 20 years has been rarely used.
2), also known as Regional Selective shunt diversion, mainly in distal splenorenal shunt and gastric coronary vein - vena cava shunt and gastric coronary - vena cava shunt. Is the theoretical basis of regional shunt: the portal vein system can be divided into spleen and mesenteric area district, regional diversion that only the lower esophageal and gastric area around the spleen and portal vein pressure and improve varicose veins to reduce bleeding. Mesenteric area while maintaining high pressure, to maximize the portal vein to maintain blood flow to the liver, liver damage and caused no increase of hepatic encephalopathy.
Among them, the distal splenorenal shunt is the distal splenic vein and left renal vein end to side anastomosis, retained spleen, cut and ligated to connect the second interval of gastric coronary vein, right gastric vein, the right gastroepiploic vein, the stomach, esophagus by the gastroepiploic vein blood flow and short gastric vein left renal vein through the splenic vein to import. This is a contemporary treatment of portal hypertension and esophageal varices up to a surgical application, especially in Europe and the United States to adopt broader. However, demanding surgical operation


difficult.
Gastric coronary - vena cava shunt is the gastric coronary vein and inferior vena cava end to side anastomosis, while for splenectomy. Gastric coronary - vena cava shunt operation more difficult, more reports on Japan, China to carry out small.
3) or said partial shunt that is restricted Portacaval shunt or superior mesenteric vein and inferior vena cava or in the middle of intercropping frame side to side anastomosis of vascular access for some man-made, or artificial blood vessel anastomosis limited to 1 cm in diameter, to limit points flow.
More limited scope of this operation, exposure and the operation is not very difficult, but how different patients to determine the appropriate size of the stoma, can reduce hepatic portal venous pressure, while maintaining the right amount of hepatic portal vein, and is not easy. And there was some points from the mesenteric vein into the vena cava blood, caused by portosystemic shunt encephalopathy.
(2) the portal azygous devascularization is esophageal and gastric devascularization and portal vein completely broken away, also is to make the portal vein and the azygos vein, Department of collateral circulation around the cardia completely blocked, so that the varicose veins subsided, to prevent further bleeding. Enlargement surgery involves removing the spleen, the free esophageal and stomach at least 6 cm proximal 1 / 2, cut off the end of the stomach and gastric coronary vein to all branches of the esophagus, including esophageal branch. In addition, under the blockade of esophageal mucosa and muscle between the venous network.
Major surgical procedures include: Esophageal variceal ligation (Crile, 1950), the abdominal varicose vein devascularization (Hassab, 1970), the pericardial blood vessel breaking procedure (Qiu, 1972), esophageal transection plus abdominal varicose vein amputation surgery (Sugiura, 1973 years). Furthermore, it was under direct vision using selective gastric coronary vein embolization, and its essence is also the portal azygos disconnection.
Advantage of portal azygos disconnection does not affect the portal vein and hepatic blood flow. But the complete devascularization is not a simple operation, a wider scope, and after the reconstruction of the collateral circulation, re-bleeding is relatively high, up to 10% -40%.
In conclusion, portal hypertension is a complex clinical problem. Shunt and devascularization have their indications, advantages and disadvantages, depending on the patient's need to select the specific circumstances.
Exp Content Document Name: portal vein arterialization in the treatment of portal hypertension Study Introduction: Objective To observe the portal vein arterialization in complete portosystemic shunt (PACS) surgery and conventional splenorenal shunt (SRS) patients and pericardial blood vessel off ( PCDV) patients of portal hemodynamics. Prepared by portal hypertension model, PCDV group splenectomy, pericardial blood vessel breaking surgery; SRS group was splenectomy, distal splenorenal shunt; PACS group was splenectomy, portal vein - splenic artery anastomosis, portal vein - vena cava anastomosis . Color Doppler ultrasound and invasive piezometer immediately after the abdominal surgery done immediately and 2 weeks after treatment measured portal venous flow (PVF) and portal vein pressure (PVP), PACS group including hepatic and into the inferior vena vein PVF, PVP. Surgery before and after testing of liver function. Results PCDV PVF 2 weeks after operation decreased by about 17%, PVP decreased by about 5%; SRS PVF group was decreased by about 2 weeks 51%, PVP decreased by about 51%; PACS group was increased to 2 weeks abdominal hepatic PVF immediately after 180% of hepatic laparotomy immediately after PVP increased to 196%, into the abdominal inferior vena cava immediately after PVF increased 130% PVP into the inferior vena cava to maintain low, about 46 immediately after laparotomy %. PACS group 2 weeks after hepatic PVP, PVF and PVF into the inferior vena cava were significantly higher than the other 2 groups (P name of portal vein arterialization in the literature for treatment of portal hypertension experimental study Article Name
English (English) translation Splenic Portal Arterialization in Treatment of Portal Hypertension; of Gang Cao; Wen-Bin Yang; Li Yiming; Qinzhao Yin; CAO Gang; YANG Wen-bin; LI Yi-ming; QIN Zhao-yin.Department of General Surgery; The Second Hospital of Xi an Jiaotong University; Xi an 710004; China;
Agencies Second Hospital of Xi'an Jiaotong University, General Surgery; Second Hospital of Xi'an Jiaotong University, Xi'an, General Surgery; Document
Article From Shanghai Institute of Metallurgy; Materials Physics and Chemistry (Professional) PhD thesis in 2000 Keywords Portal hypertension; treatment; portal vein arterialization; KeywordsPortal hypertension Treatment Portal arterialization;


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