Brief Article
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World J Gastroenterol. Aug 7, 2011; 17(29): 3453-3458
Published online Aug 7, 2011. doi: 10.3748/wjg.v17.i29.3453
Long-term results of small-diameter proximal splenorenal venous shunt: A retrospective study
Hao Chen, Wei-Ping Yang, Ji-Qi Yan, Qin-Yu Li, Di Ma, Hong-Wei Li
Hao Chen, Wei-Ping Yang, Ji-Qi Yan, Qin-Yu Li, Di Ma, Hong-Wei Li, Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Author contributions: Chen H designed the study, performed operation and follow-up and wrote the manuscript; Yan JQ and Li QY performed data collection and part of statistical analysis; Ma D recruited patients; Li HW performed most of operations; Yang WP is involved in the design of the study and preparation of the manuscript; all authors read and approved the manuscript.
Correspondence to: Wei-Ping Yang, MD, Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Erlu, Shanghai 200025, China. yangweipingmd@126.com
Telephone: +86-21-64370045 Fax: +86-21-64333548
Received: October 21, 2010
Revised: November 15, 2010
Accepted: November 22, 2010
Published online: August 7, 2011
Abstract

AIM: To investigate recurrent variceal hemorrhage and long-term survival rates of patients treated with partial proximal splenorenal venous shunt.

METHODS: Patients with variceal hemorrhage who were treated with small-diameter proximal splenorenal venous shunt in Ruijin Hospital between 1996 and 2009 were included in this study. Shunt diameter was determined before operation using Duplex Doppler ultrasonography. Peri-operative and long-term results in term of rehemorrhage, encephalopathy and mortality were followed up.

RESULTS: Ninety-eight patients with Child A and B variceal hemorrhage received small-diameter proximal splenorenal venous shunt with a diameter of 7-10 mm. After operation, the patients’ mean free portal pressure (P < 0.01) and the flow rate of main portal vein (P < 0.01) decreased significantly compared with that before operation. The rates of rebleeding and mortality were 6.12% (6 cases) and 2.04% (2 cases), respectively. Ninety-one patients were followed up for 7 mo-14 years (median, 48.57 mo). Long-term rates of rehemorrhage and encephalopathy were 4.40% (4 cases) and 3.30% (3 cases), respectively. Thirteen patients (14.29%) died mainly due to progressive hepatic dysfunction. Five- and ten-year survival rates were 82.12% and 71.24%, respectively.

CONCLUSION: Small-diameter proximal splenorenal venous shunt affords protection against variceal rehemorrhage with a low occurrence of encephalopathy in patients with normal liver function.

Keywords: Partial portacaval shunt; Hemorrhage; Esophageal varices; Shunt diameter; Encephalopathy