1964 年 61 巻 12 号 p. 1029-1048
Splenorenal shunt has some advantages over other procedures for portal hypertension. Removal of the spleen in this procedure may correct the condition of hypersplenisrn secondary to the portal bed block. Surgical risk in this procedure is ususlly less than that of portacaval anastomosis, in the sense that there is less frequent liver failure and ammonia intoxication after anastomosis. The sprenorenal shunt, however, is inferior to portacaval shunt as to effectiveness on portal decompression and it thromboses more easily. Considering these facts, we have recently devised a new operative procedure, splenocaval shunt, for the treatment of portal hypertension, and 16 patients were treated with this procedu
This report is concerned with experimental and clinical studies on the efficacy of the splenocaval shunt.
1) The effect of this procedure on portal pressure decompsession was theoretically investigated with an aid of a model resembling the vascular system.
2) The postoperative change in hemodynamics in portal system was studied by determining free portal pressure (FPP) and occluded hepatic protal pressure (OHPP) as well as by using the dye dilution technique.
3) Beneficial effects of this procedure on laboratory examination data including liver function test, esophageal varices as well as the postoperative course were analyzed in clinical patients.
The results obtained may be summarized as follows:
1) The model experiment indicated that the splenocaval shunt is more effective in reducing the portal pressure than the splenorenal shunt.
2) OHPP was lower than FPP in 6 dogs and 6 patients with splenocaval shunts. This fact was interpreted as indicating that blood was flowing into the liver in spite of the presence of a direct connection between the portal system and the caval system through splenocaval shunt. In 2 patients, however, the relationship between OHPP and FPP was reversed, indicating a reversed blood flow in the proximal segment of the portal vein.
A similar result was obtained in the dye dilution study.
3) Since October 1961 sixteen patients have been treated with this procedure and nine of these are still doing well 5 to 24 months after surgery. Reduction in portal pressure by this procedure ranged between 50 and 330 mmH2O, with a mean of 144 mmH2O from preoperative value. Esophageal varices have completely disappeared or markedly diminished in 11 out of 14 patients. However, recurrence of esophageal bleeding after this procedure was noted in 3 out of 9.
From the experimental and clinical data mentioned above, it was concluded that the splenocaval shunt was efficient procedure for portal hypertension, and was also superior to the splenorenal shunt in the effect on decompressing portal pressure.