目的探讨防止限制性门腔静脉侧侧分流术后吻合口扩大的方法。方法对32例肝硬变门脉高压症患者行限制性门腔静脉分流术，术中采用不吸收缝线连续缝合门腔静脉吻合口前后壁形成自然的限制环，以防止术后吻合口的扩大。结果32例患者于术后3～36个月行彩超或螺旋CT检查，显示门腔静脉吻合口均无扩大； 术后再出血率为3.1%（1/32），肝性脑病发生率为6.3%（2/32）； 术后≤6个月时肝功能均有不同程度改善，与术前比较其差异有显著性（P＜0.001）； 全部病例随访6~49个月，随访率为100%。结论改良的限制性门腔静脉侧侧分流术是治疗肝硬变门脉高压症的有效方法。
目的 提高对儿童Abernethy畸形的认识。 方法 归纳总结2001年1月－2012年11月我国文献报道的13例儿童Abernethy畸形(即先天性肝外门腔分流，临床分为Ⅰa型、Ⅰb 型和Ⅱ型)的临床表现和治疗方法。 结果 13例儿童Abernethy畸形中，11例Ⅰ型（Ⅰa型4例、Ⅰb型7例）和2例Ⅱ型患儿，1岁内发病6例，确诊前病程≥5年6例。在11例Ⅰ型患儿中，便血3例，呕血4例，肝功能异常4例，肝硬化1例，肝性脑病2例，肝脏结节3例，脾脏肿大4例，脾功能亢进3例，门脉高压3例，合并畸形3例。在2例Ⅱ型患儿中，便血1例，肝功能异常伴肝硬化、脾脏肿大和脾功能亢进1例，肝脏结节1例；无呕血和合并畸形。门脉系统血液分流到下腔静脉2例、髂内静脉4例、左肾静脉1例、奇静脉1例、右心房2例和盆静脉丛1例，其余2例不详。患儿多采用保守治疗，如有巨脾、便血或呕血，脾脏切除和结扎乙状结肠周围血管手术也有采用。 结论 Abernethy畸形以Ⅰ型患儿为主，发病年龄较早，临床表现不具特异性。诊断依赖于影像学检查，螺旋CT血管造影对诊断有较高价值。个体化治疗应根据畸形类型和病情而定。
Objective To evaluate the feasibility of X-ray guided access to the extrahepatic segment of the main portal vein (PV) to create a transjugular extrahepatic portacaval shunt (TEPS). Methods 5F pigtail catheter was inserted into the main PV as target catheter by percutaneous transhepatic path under ultrasound guidance. The RUPS-100 puncture system was inserted into the inferior vena cava (IVC) by transjugular path under ultrasound guidance. Fluency covered stent was deployed to create the extrahepatic portacaval shunt after puncturing the target catheter from the IVC under the X-ray guidance, then shunt venography was performed. Enhanced CT of the abdomen helped identify and quantify the patency of the shunt and the presence of hemoperitoneum. Results The extrahepatic portacaval shunts were created successfully by only 1 puncture in 6 pigs. No extravasation was observed in shunt venography. One pig died of anesthesia on the day of operation. The extrahepatic portacaval shunts were failed in 2 pigs 3 days after the operation (one was occluded and the other one was narrowed by 80%). The extrahepatic portacaval shunts were occluded 2 weeks after the operation in the remaining 3 pigs. The shunts were out of the liver and no hemoperitoneum was identified at necropsy in the 6 pigs. Conclusion TEPS is technically safe and feasible under the X-ray guidance.