Effects of selective shunt plus devascularization on splanchnic hemodynamics / 中华普通外科杂志

ABSTRACT

Objective To evaluate the changes of splanchnic hemodynamics after selective decongestive devascularization shunt of gustrosplenic region (SDDS-GSR) in the treatment of patients with portal hypertension. Methods All these 41 portal hypertensive patients underwent a combination surgery including partially occlusion of the splenic artery, Warren distal splenorenal shunt and devascularization. Postoperative patients were followed-up by ultrasonography for changes of splanchnic hemodynamics. Results were compared with that of 21 healthy volunteers. Results The thickness of spleen 2 weeks and 1 year after surgery (47±8) mm, (46±8) nun decreased from preoperative (60±9) mm (P<0.01). The diameter of portal vein (1.13±0.19) cm and splenic artery (0.49±0.08) cm 2 weeks after surgery decreased (P<0.05) and that of hepatic artery (0.40±0.07) cm increased (P<0.05). Patients' preoperative portal vein blood flow volume (1716±1262) ml/min and splenic artery (1269±570) ml/min were larger than that of normal group (P<0.05), while that of hepatic artery (321±126) ml/min was significantly less than that of normal group (P<0.05). The portal blood flow (649±294) ml/min and that of splenic artery (446±254) ml/min 2 weeks after surgery decreased significantly (P<0.01). The hepatic artery blood flow (612±295) ml/min increased significantly (P<0.01). When reevaluated at 1 year the hepatic artery blood flow (401±152) ml/min was not significantly different compared with that before surgery and that in normal group (P>0.05). Conclusions There are significant alterations in hepatic and splenic hemodynamics in patients with portal hypertension, and that SDDS-GSR can partially reverse the chaos of the hepatic and splenic hemodynamics in cirrhotic portal hypertensive patients.