Progress and prospect of selective shunt for portal hypertension_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 TIAN Mingguo

Department of Hepatobiliary Surgery, The People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, P. R. China;

Corresponding author：

TIAN Mingguo, Email: tian88@hotmail.com

Keywords：

portal hypertension; gastroesophageal vairices; selective shunting; progress

DOI：

10.7507/1007-9424.202204008

Video：

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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.

Citation： TIAN Mingguo. Progress and prospect of selective shunt for portal hypertension. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(8): 987-991. doi: 10.7507/1007-9424.202204008 Copy

1.	Vidal M. Traitement chirurgical des ascites dans les cirrhoses du foie. 16th Cong Franc Chir, 1903, 16: 294-296.
2.	Whipple AO. The problem of portal hypertension in relation to the hepatosplenopathies. Ann Surg, 1945, 122(4): 449-475.
3.	Rikkers LF. Bleeding esophageal varices. Surg Clin North Am, 1987, 67(3): 475-488.
4.	Starzl TE, Francavilla A, Halgrimson CG, et al. The origin, hormonal nature, and action of hepatotrophic substances in portal venous blood. Surg Gynecol Obstet. 1973, 137(2): 179-199.
5.	Rosemurgy AS, Serafini FM, Zervos EE, et al. Small-diameter prosthetic H-graft portacaval shunt: definitive therapy for variceal bleeding. J Gastrointest Surg, 1998, 2(6): 585-591.
6.	Cowgill SM, Thometz D, Clark W, et al. Conventional predictors of survival poorly predict and significantly underpredict survival after H-graft portacaval shunts. J Gastrointest Surg, 2007, 11(1): 89-94.
7.	王宇, 张忠涛, 李建设, 等. 不断发展和改良的门腔静脉侧侧分流术—努力降低术后脑病的发生率, 维持和保护肝脏功能. 中华肝胆外科杂志, 2002, 8(1): 9-12.
8.	Warren WD, Zeppa R, Fomon JJ. Selective trans-splenic decompression of gastroesophageal varices by distal splenorenal shunt. Ann Surg, 1967, 166(3): 437-455.
9.	Ezzat FA, Abu-Elmagd KM, Aly MA, et al. Selective shunt versus nonshunt surgery for management of both schistosomal and nonschistosomal variceal bleeders. Ann Surg, 1990, 212(1): 97-108.
10.	Abu-Elmagd KM, Aly MA, Fathy OM, et al. Ten years of experience with patients with chronic active liver disease variceal bleeding: ablative versus selective decompressive therapy. Surgery, 1993, 114(5): 868-881.
11.	Henderson JM, Millikan WJ, Warren WD. The distal splenorenal shunt: an update. World J Surg, 1984, 8(5): 722-732.
12.	Iliopoulos JI, Thomas JH, Pierce GE, et al. Splenocaval shunt for selective portal decompression. World J Surg, 1988, 12(6): 852-855.
13.	董家鸿, 刘吉奎, 蔡景修. 选择性远端脾腔分流术的评价. 中国实用外科杂志, 2002, 22(4): 212-214.
14.	Inokuchi K. A selective portacaval shunt. Lancet, 1968, 2(7558): 51-52.
15.	田明国, 贾东, 杨勇, 等. 选择性脾胃区静脉分流治疗门静脉高压症的临床疗效. 中华消化外科杂志, 2020, 19(12): 1286-1292.
16.	Warren WD, Millikan WJ Jr, Henderson JM, et al. Selective variceal decompression after splenectomy or splenic vein thrombosis. With a note on splenopancreatic disconnection. Ann Surg, 1984, 199(6): 694-702.
17.	马宽生, 何振平, 蔡景修, 等. 选择性、非选择性分流术对门静脉高压症的疗效比较(附60例报告). 中国实用外科杂志, 1996, 16(8): 489-490,508.
18.	王青, 董瑞, 杜锡林, 等. 远端脾肾分流术联合脾部分切除治疗门静脉高压症脾功能亢进疗效探讨. 中国实用外科杂志, 2011, 31(4): 322-324.
19.	Jin GL, Rikkers LF. The significance of portal vein thrombosis after distal splenorenal shunt. Arch Surg, 1991, 126(8): 1011-1015.
20.	Spina GP, Santambrogio R, Opocher E, et al. Early hemodynamic changes following selective distal splenorenal shunt for portal hypertension: comparison of surgical techniques. World J Surg, 1990, 14(1): 115-121.
21.	Wood RP, Shaw BW, Rikkers LF. Liver transplantation for variceal hemorrhage. Surg Clin North Am, 1990, 70(2): 449-461.
22.	吴金花, 辛国军, 田明国, 等. 脾切除联合贲门周围血管离断术后早期门静脉系统血栓分布及其发生率. 中华普通外科学文献(电子版), 2021, 15(3): 168-171.
23.	田明国, 李宝定, 辛国军, 等. 门静脉高压症脾切除术中脾静脉近端结扎预防门静脉血栓的疗效分析. 中华普通外科杂志, 2021, 36(1): 39-42.
24.	Belghiti J, Grenier P, Nouel O, et al. Long-term loss of Warren’s shunt selectivity. Angiographic demonstration. Arch Surg, 1981, 116(9): 1121-1124.
25.	Warren WD, Millikan WJ, Henderson JM, et al. Splenopancreatic disconnection. Improved selectivity of distal splenorenal shunt. Ann Surg, 1986, 204(4): 346-355.
26.	Ashida H, Utsunomiya J, Kotoura Y, et al. Results of distal splenorenal shunt with versus without splenopancreatic disconnection. J Clin Gastroenterol, 1989, 11(6): 658-662.
27.	Richards WO, Pearson TC, Henderson JM, et al. Evaluation and treatment of early hemorrhage of the alimentary tract after selective shunt procedures. Surg Gynecol Obstet. 1987, 164(6): 530-536.
28.	田明国, 杨立玲. 远端脾肾分流术后无吻合口梗阻的重度脾功能亢进一例. 中华消化外科杂志, 2013, 12(4): 314.
29.	Bhalerao RA, Pinto AC, Bapat RD, et al. Selective transplenic decompression of oesophageal varices by distal splenorenal and splenocaval shunt. Gut, 1978, 19(9): 831-837.
30.	Gajin P, Radević B, Nenezić D, et al. Distal splenorenal shunt with partial spleen resection. Srp Arh Celok Lek, 2007, 135(5-6): 293-297.
31.	Inokuchi K, Sugimachi K. The selective shunt for variceal bleeding: a personal perspective. Am J Surg, 1990, 160(1): 48-53.
32.	戴植本, 龚本琼, 裘法祖. 胃左静脉腔静脉分流术. 中国实用外科杂志, 2001, 21(10): 617-618.
33.	王瑞涛, 刘昌, 白纪刚, 等. 冠腔静脉分流术治疗门静脉高压症. 中华肝脏外科手术学电子杂志, 2017, 6(4): 248-250.
34.	田明国, 杨勇, 杜鹏, 等. 脾切除后经脾静脉冠肾静脉分流术治疗门静脉高压症. 中华消化外科杂志, 2016, 15(7): 735-741.
35.	Tian M, Yang Y, Jia D. Coronary renal shunt with splenectomy (CRSS) for selective variceal decompression. World J Surg, 2019, 43(2): 590-593.
36.	Nagasue N, Ogawa Y, Hirose S, et al. Bilateral gastric venous decompression by a modified Warren shunt. Br J Surg, 1985, 72(3): 199-201.
37.	田明国, 贾东, 刘明奇, 等. 经脾静脉和肠系膜下静脉冠肾分流术治疗门静脉高压症. 肝胆胰外科杂志, 2019, 31(3): 157-160.
38.	中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版). 中华外科杂志, 2019, 57(12): 885-892.
39.	Hermann RE, Henderson JM, Vogt DP, et al. Fifty years of surgery for portal hypertension at the Cleveland Clinic Foundation. Lessons and prospects. Ann Surg, 1995, 221(5): 459-466.
40.	Orozco H, Mercado MA, Granados Garcia J, et al. Selective shunts for portal hypertension: current role of a 21-year experience. Liver Transpl Surg, 1997, 3(5): 475-480.
41.	Mazzaferro V, Todo S, Tzakis AG, et al. Liver transplantation in patients with previous portasystemic shunt. Am J Surg, 1990, 160(1): 111-116.
42.	Zeng DB, Di L, Zhang RC, et al. The effect of splenectomy on the reversal of cirrhosis: a prospective study. Gastroenterol Res Pract, 2019, 2019: 5459427. doi: 10.1155/2019/5459427. eCollection 2019.
43.	Jung YK, Yim HJ. Reversal of liver cirrhosis: current evidence and expectations. Korean J Intern Med, 2017, 32(2): 213-228.

1. Vidal M. Traitement chirurgical des ascites dans les cirrhoses du foie. 16th Cong Franc Chir, 1903, 16: 294-296.
2. Whipple AO. The problem of portal hypertension in relation to the hepatosplenopathies. Ann Surg, 1945, 122(4): 449-475.
3. Rikkers LF. Bleeding esophageal varices. Surg Clin North Am, 1987, 67(3): 475-488.
4. Starzl TE, Francavilla A, Halgrimson CG, et al. The origin, hormonal nature, and action of hepatotrophic substances in portal venous blood. Surg Gynecol Obstet. 1973, 137(2): 179-199.
5. Rosemurgy AS, Serafini FM, Zervos EE, et al. Small-diameter prosthetic H-graft portacaval shunt: definitive therapy for variceal bleeding. J Gastrointest Surg, 1998, 2(6): 585-591.
6. Cowgill SM, Thometz D, Clark W, et al. Conventional predictors of survival poorly predict and significantly underpredict survival after H-graft portacaval shunts. J Gastrointest Surg, 2007, 11(1): 89-94.
7. 王宇, 张忠涛, 李建设, 等. 不断发展和改良的门腔静脉侧侧分流术—努力降低术后脑病的发生率, 维持和保护肝脏功能. 中华肝胆外科杂志, 2002, 8(1): 9-12.
8. Warren WD, Zeppa R, Fomon JJ. Selective trans-splenic decompression of gastroesophageal varices by distal splenorenal shunt. Ann Surg, 1967, 166(3): 437-455.
9. Ezzat FA, Abu-Elmagd KM, Aly MA, et al. Selective shunt versus nonshunt surgery for management of both schistosomal and nonschistosomal variceal bleeders. Ann Surg, 1990, 212(1): 97-108.
10. Abu-Elmagd KM, Aly MA, Fathy OM, et al. Ten years of experience with patients with chronic active liver disease variceal bleeding: ablative versus selective decompressive therapy. Surgery, 1993, 114(5): 868-881.
11. Henderson JM, Millikan WJ, Warren WD. The distal splenorenal shunt: an update. World J Surg, 1984, 8(5): 722-732.
12. Iliopoulos JI, Thomas JH, Pierce GE, et al. Splenocaval shunt for selective portal decompression. World J Surg, 1988, 12(6): 852-855.
13. 董家鸿, 刘吉奎, 蔡景修. 选择性远端脾腔分流术的评价. 中国实用外科杂志, 2002, 22(4): 212-214.
14. Inokuchi K. A selective portacaval shunt. Lancet, 1968, 2(7558): 51-52.
15. 田明国, 贾东, 杨勇, 等. 选择性脾胃区静脉分流治疗门静脉高压症的临床疗效. 中华消化外科杂志, 2020, 19(12): 1286-1292.
16. Warren WD, Millikan WJ Jr, Henderson JM, et al. Selective variceal decompression after splenectomy or splenic vein thrombosis. With a note on splenopancreatic disconnection. Ann Surg, 1984, 199(6): 694-702.
17. 马宽生, 何振平, 蔡景修, 等. 选择性、非选择性分流术对门静脉高压症的疗效比较(附60例报告). 中国实用外科杂志, 1996, 16(8): 489-490,508.
18. 王青, 董瑞, 杜锡林, 等. 远端脾肾分流术联合脾部分切除治疗门静脉高压症脾功能亢进疗效探讨. 中国实用外科杂志, 2011, 31(4): 322-324.
19. Jin GL, Rikkers LF. The significance of portal vein thrombosis after distal splenorenal shunt. Arch Surg, 1991, 126(8): 1011-1015.
20. Spina GP, Santambrogio R, Opocher E, et al. Early hemodynamic changes following selective distal splenorenal shunt for portal hypertension: comparison of surgical techniques. World J Surg, 1990, 14(1): 115-121.
21. Wood RP, Shaw BW, Rikkers LF. Liver transplantation for variceal hemorrhage. Surg Clin North Am, 1990, 70(2): 449-461.
22. 吴金花, 辛国军, 田明国, 等. 脾切除联合贲门周围血管离断术后早期门静脉系统血栓分布及其发生率. 中华普通外科学文献(电子版), 2021, 15(3): 168-171.
23. 田明国, 李宝定, 辛国军, 等. 门静脉高压症脾切除术中脾静脉近端结扎预防门静脉血栓的疗效分析. 中华普通外科杂志, 2021, 36(1): 39-42.
24. Belghiti J, Grenier P, Nouel O, et al. Long-term loss of Warren’s shunt selectivity. Angiographic demonstration. Arch Surg, 1981, 116(9): 1121-1124.
25. Warren WD, Millikan WJ, Henderson JM, et al. Splenopancreatic disconnection. Improved selectivity of distal splenorenal shunt. Ann Surg, 1986, 204(4): 346-355.
26. Ashida H, Utsunomiya J, Kotoura Y, et al. Results of distal splenorenal shunt with versus without splenopancreatic disconnection. J Clin Gastroenterol, 1989, 11(6): 658-662.
27. Richards WO, Pearson TC, Henderson JM, et al. Evaluation and treatment of early hemorrhage of the alimentary tract after selective shunt procedures. Surg Gynecol Obstet. 1987, 164(6): 530-536.
28. 田明国, 杨立玲. 远端脾肾分流术后无吻合口梗阻的重度脾功能亢进一例. 中华消化外科杂志, 2013, 12(4): 314.
29. Bhalerao RA, Pinto AC, Bapat RD, et al. Selective transplenic decompression of oesophageal varices by distal splenorenal and splenocaval shunt. Gut, 1978, 19(9): 831-837.
30. Gajin P, Radević B, Nenezić D, et al. Distal splenorenal shunt with partial spleen resection. Srp Arh Celok Lek, 2007, 135(5-6): 293-297.
31. Inokuchi K, Sugimachi K. The selective shunt for variceal bleeding: a personal perspective. Am J Surg, 1990, 160(1): 48-53.
32. 戴植本, 龚本琼, 裘法祖. 胃左静脉腔静脉分流术. 中国实用外科杂志, 2001, 21(10): 617-618.
33. 王瑞涛, 刘昌, 白纪刚, 等. 冠腔静脉分流术治疗门静脉高压症. 中华肝脏外科手术学电子杂志, 2017, 6(4): 248-250.
34. 田明国, 杨勇, 杜鹏, 等. 脾切除后经脾静脉冠肾静脉分流术治疗门静脉高压症. 中华消化外科杂志, 2016, 15(7): 735-741.
35. Tian M, Yang Y, Jia D. Coronary renal shunt with splenectomy (CRSS) for selective variceal decompression. World J Surg, 2019, 43(2): 590-593.
36. Nagasue N, Ogawa Y, Hirose S, et al. Bilateral gastric venous decompression by a modified Warren shunt. Br J Surg, 1985, 72(3): 199-201.
37. 田明国, 贾东, 刘明奇, 等. 经脾静脉和肠系膜下静脉冠肾分流术治疗门静脉高压症. 肝胆胰外科杂志, 2019, 31(3): 157-160.
38. 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版). 中华外科杂志, 2019, 57(12): 885-892.
39. Hermann RE, Henderson JM, Vogt DP, et al. Fifty years of surgery for portal hypertension at the Cleveland Clinic Foundation. Lessons and prospects. Ann Surg, 1995, 221(5): 459-466.
40. Orozco H, Mercado MA, Granados Garcia J, et al. Selective shunts for portal hypertension: current role of a 21-year experience. Liver Transpl Surg, 1997, 3(5): 475-480.
41. Mazzaferro V, Todo S, Tzakis AG, et al. Liver transplantation in patients with previous portasystemic shunt. Am J Surg, 1990, 160(1): 111-116.
42. Zeng DB, Di L, Zhang RC, et al. The effect of splenectomy on the reversal of cirrhosis: a prospective study. Gastroenterol Res Pract, 2019, 2019: 5459427. doi: 10.1155/2019/5459427. eCollection 2019.
43. Jung YK, Yim HJ. Reversal of liver cirrhosis: current evidence and expectations. Korean J Intern Med, 2017, 32(2): 213-228.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress and prospect of selective shunt for portal hypertension

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