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, 張忠濤, 李建設, 等. 不斷發展和改良的門腔靜脈側側分流術—努力降低術后腦病的發生率, 維持和保護肝臟功能. 中華肝膽外科雜志, 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.	董家鴻, 劉吉奎, 蔡景修. 選擇性遠端脾腔分流術的評價. 中國實用外科雜志, 2002, 22(4): 212-214.
14.	Inokuchi K. A selective portacaval shunt. Lancet, 1968, 2(7558): 51-52.
15.	田明國, 賈東, 楊勇, 等. 選擇性脾胃區靜脈分流治療門靜脈高壓癥的臨床療效. 中華消化外科雜志, 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.	馬寬生, 何振平, 蔡景修, 等. 選擇性、非選擇性分流術對門靜脈高壓癥的療效比較(附60例報告). 中國實用外科雜志, 1996, 16(8): 489-490,508.
18.	王青, 董瑞, 杜錫林, 等. 遠端脾腎分流術聯合脾部分切除治療門靜脈高壓癥脾功能亢進療效探討. 中國實用外科雜志, 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.	吳金花, 辛國軍, 田明國, 等. 脾切除聯合賁門周圍血管離斷術后早期門靜脈系統血栓分布及其發生率. 中華普通外科學文獻(電子版), 2021, 15(3): 168-171.
23.	田明國, 李寶定, 辛國軍, 等. 門靜脈高壓癥脾切除術中脾靜脈近端結扎預防門靜脈血栓的療效分析. 中華普通外科雜志, 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.	田明國, 楊立玲. 遠端脾腎分流術后無吻合口梗阻的重度脾功能亢進一例. 中華消化外科雜志, 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, Radevi? B, Nenezi? 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, 龔本瓊, 裘法祖. 胃左靜脈腔靜脈分流術. 中國實用外科雜志, 2001, 21(10): 617-618.
33.	王瑞濤, 劉昌, 白紀剛, 等. 冠腔靜脈分流術治療門靜脈高壓癥. 中華肝臟外科手術學電子雜志, 2017, 6(4): 248-250.
34.	田明國, 楊勇, 杜鵬, 等. 脾切除后經脾靜脈冠腎靜脈分流術治療門靜脈高壓癥. 中華消化外科雜志, 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.	田明國, 賈東, 劉明奇, 等. 經脾靜脈和腸系膜下靜脈冠腎分流術治療門靜脈高壓癥. 肝膽胰外科雜志, 2019, 31(3): 157-160.
38.	中華醫學會外科學分會脾及門靜脈高壓外科學組. 肝硬化門靜脈高壓癥食管、胃底靜脈曲張破裂出血診治專家共識(2019版). 中華外科雜志, 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, 張忠濤, 李建設, 等. 不斷發展和改良的門腔靜脈側側分流術—努力降低術后腦病的發生率, 維持和保護肝臟功能. 中華肝膽外科雜志, 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. 董家鴻, 劉吉奎, 蔡景修. 選擇性遠端脾腔分流術的評價. 中國實用外科雜志, 2002, 22(4): 212-214.
14. Inokuchi K. A selective portacaval shunt. Lancet, 1968, 2(7558): 51-52.
15. 田明國, 賈東, 楊勇, 等. 選擇性脾胃區靜脈分流治療門靜脈高壓癥的臨床療效. 中華消化外科雜志, 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. 馬寬生, 何振平, 蔡景修, 等. 選擇性、非選擇性分流術對門靜脈高壓癥的療效比較(附60例報告). 中國實用外科雜志, 1996, 16(8): 489-490,508.
18. 王青, 董瑞, 杜錫林, 等. 遠端脾腎分流術聯合脾部分切除治療門靜脈高壓癥脾功能亢進療效探討. 中國實用外科雜志, 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. 吳金花, 辛國軍, 田明國, 等. 脾切除聯合賁門周圍血管離斷術后早期門靜脈系統血栓分布及其發生率. 中華普通外科學文獻(電子版), 2021, 15(3): 168-171.
23. 田明國, 李寶定, 辛國軍, 等. 門靜脈高壓癥脾切除術中脾靜脈近端結扎預防門靜脈血栓的療效分析. 中華普通外科雜志, 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. 田明國, 楊立玲. 遠端脾腎分流術后無吻合口梗阻的重度脾功能亢進一例. 中華消化外科雜志, 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, Radevi? B, Nenezi? 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, 龔本瓊, 裘法祖. 胃左靜脈腔靜脈分流術. 中國實用外科雜志, 2001, 21(10): 617-618.
33. 王瑞濤, 劉昌, 白紀剛, 等. 冠腔靜脈分流術治療門靜脈高壓癥. 中華肝臟外科手術學電子雜志, 2017, 6(4): 248-250.
34. 田明國, 楊勇, 杜鵬, 等. 脾切除后經脾靜脈冠腎靜脈分流術治療門靜脈高壓癥. 中華消化外科雜志, 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. 田明國, 賈東, 劉明奇, 等. 經脾靜脈和腸系膜下靜脈冠腎分流術治療門靜脈高壓癥. 肝膽胰外科雜志, 2019, 31(3): 157-160.
38. 中華醫學會外科學分會脾及門靜脈高壓外科學組. 肝硬化門靜脈高壓癥食管、胃底靜脈曲張破裂出血診治專家共識(2019版). 中華外科雜志, 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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