Objective To evaluate the effect of triplex operations (splenopneumopexy, portal azygous devascularization and ligation of splenic artery) for children with extrahepatic portal hypertension. Methods From March 1993 to November 1998, 7 children with extrahepatic portal hypertension underwent triplexoperations. The diagnosis for these patients were confirmed by gastroscopy, barium meal and Doppler ultrasonography. The number of WBCand platelet and the hepatic function were checked before and after operations.And the free portal pressures were checked before and after ligations of the splenic artery. All patients were followed up for 2 to 8 years (5.6 years on average). The episodes of upper gastrointestinal bleeding were recorded. The degrees of varices of distal esophagus and proximal stomach were assessed by barium mealand gastroscopy. The diameters of the splenic and portal veins were obtained byBultrasound. The portopulmonary shunt and portal blood flow were evaluated by color Doppler flow image. The indices of hemorheology such as hematocrit, viscosity of whole blood and plasma, and the index of deformability and aggregability of RBC were obtained through viscometer (R-20 Seerle, Beijing). Results There was no operative fatal case in this group. Postoperatively, hemorrhage from the esophagus and gastric varices was completely controlled. Although the diameter of spleen reduced progressively, no patient’s spleen recovered to normal size during the follow up period. The degree of varices was mitigated and the free portal pressure was significantly decreased to （34.48±5.71） cm H2 O from the preoperative one （42.62±6.72） cm H2 O (P＜0.05). The rate of portal flow was alsodecreased. The direction of portal vein was bidirection (one part was away from the liver and the other was toward the liver). The number of WBC and platelet and the viscosity of whole blood and hematocrit were increased to normal value after operation. Conclusion The triplex operation is an effective procedure for the control of hemorrhage from varices in children with extrahepatic portal hypertension.
Objective To analyze the effect of monitoring and modulating the portal vein pressure and blood flow during living donor liver transplantation （LDLT） on preventing small-for-size-syndrome (SFSS). Methods Data of forty-four LDLT recipients between Oct.2007 and Oct.2008 were reviewed. Actual graft-to-recipient weight ratio（GRWR）, portal vein flow and pressure during operation and syndrome of SFSS after operation were recorded. The patients received splenectomy or splenic artery ligation according to actual GRWR, portal vein flow and pressure and WBC. Relationships between patients’ GRWR, portal vein flow, portal vein pressure and occurrence of SFSS were analyzed. Results Six patients received splenectomy and 7 patients received splenic artery ligation to decrease the portal vein flow and pressure during the operation. The portal vein flow and pressure decreased after splenectomy （Plt;0.05）. The portal vein pressure decreased （Plt;0.05） and the portal vein flow had no significant change after splenic artery ligation （P＞0.05）. No SFSS occurred after operation. Conclusion Modulation of portal vein flow and pressure by splenectomy or splenic artery ligation during LDLT operation can decrease the portal vein flow and pressure, and which can prevent the incidence of SFSS.
目的 总结应用脾动脉结扎加脾部分切除术治疗外伤性脾破裂的临床经验。方法 对本院近8年间收治的64例接受脾动脉结扎加脾部分切除治疗的脾外伤患者的临床资料进行回顾性分析，重点分析脾部分切除术的手术方法、临床疗效和适应证。结果 术中双重结扎脾动脉，然后根据脾脏损伤的情况决定保留脾脏的部位，保证残脾不少于原脾体积的30%。全组无手术死亡病例，术后出现早期并发症者16例（25.0%），其中发热8例，脾窝积液1例，肠梗阻2例，左侧胸腔积液3例，切口感染2例，均经对症处理后治愈。结论 对部分外伤性脾破裂患者的治疗选择脾动脉结扎加脾部分切除术是安全可行的。
ObjectiveTo summarize the recent development of surgical treatment for portal hypertension with hypersplenism. MethodsThe related literatures on various operation treatment of hypertension with hypersplenism at home and abroad in recent years were collected and reviewed. ResultsThere are many operation treatment methods of hypertension with hypersplenism, includes the pericardial devascularization, subtotal splenectomy, partial splenic embolization, spleen radiofrequency ablation, splenic artery ligation, distal splenorenal shunt, and so on. The different operation methods each has its advantages and disadvantages, but there are a certain percentage of the incidence of complications. At the same time, due to the limited understanding of the function of the spleen in portal hypertension, the treatment of "resecting" or "reserving" spleen has always been the hot spot of the academic dispute. ConclusionFor what kind of operation method is the most suitable for the treatment of hypertension with hypersplenism is no fixed conclusion.