目的:探讨选择性脾胃区静脉分流治疗门静脉高压症的临床疗效。方法:采用回顾性描述性研究方法。收集2016年9月至2019年8月宁夏回族自治区人民医院收治的68例门静脉高压症患者的临床病理资料；男46例，女22例；中位年龄为48岁，年龄范围为26～71岁。根据术前CT检查胃食管静脉曲张周围的血管走行及术中血流动力学评估结果行选择性脾胃区静脉分流术。观察指标：(1)手术及术后情况。(2)随访情况。采用门诊或电话方式进行随访，术后3～6个月行胃镜及门静脉CT检查，之后每6个月复查1次肝功能、甲胎蛋白及肝胆B超。了解患者肝功能、血小板计数、凝血功能及胃食管静脉曲张情况。随访时间截至2020年2月。偏态分布的计量资料以n M(范围)表示。计数资料以绝对数或百分比表示。n 结果:(1)手术及术后情况：68例患者中，30例行选择性脾胃区静脉分流术，其中脾切除联合冠肾分流术16例、脾切除联合冠腔分流术7例、远端脾肾分流术5例、肠系膜下静脉肾静脉分流术1例、胃网膜右静脉-下腔静脉分流术1例；38例经自发性门腔分流行选择性脾胃区静脉分流术，其中经自发性胃肾分流选择性胃静脉分流术33例，经自发性脾肾分流选择性胃静脉分流术3例，经自发性脾肾分流选择性脾胃区静脉分流术2例。68例患者中，无手术死亡病例，术后腹腔内出血需二次手术止血1例，腹腔感染1例，轻度肝性脑病1例，轻型肺栓塞1例。(2)随访情况：68例患者均获得随访，随访时间为18个月(6～36个月)。患者术后肝功能及腹腔积液程度均明显改善，5例经自发性胃肾分流的选择性分流术患者发生门静脉血栓，发生率为15.2%(5/33)。术后胃镜及CT检查结果示31例胃食管静脉曲张消失，34例轻度残留，3例复发包括胃网膜右静脉下腔静脉分流后吻合口狭窄导致破裂再出血1例，经再次手术后痊愈。3例患者术后发生原发性肝癌。结论:根据患者门静脉血流动力学特点选择不同脾胃区静脉分流方式，能有效预防和治疗胃食管静脉曲张破裂出血并改善肝脏功能。“,”Objective:To investigate the clinical efficacy of selective venous shunts of gastrosplenic area for portal hypertension.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 68 patients with portal hypertension who were admitted to the People′s Hospital of Ning Xia Autonomous Region from Semptember 2016 to August 2019 were collected. There were 46 males and 22 females, aged from 26 to 71 years, with a median age of 48 years. Selective venous shunts of gastrosplenic area were performed according to evaluation results on preoperative vessel course around gastroesophageal varices by computed tomography (CT) and on intraoperative portal hemodynamics. Observation indicatores: (1) surgical and postoperative situations; (2) follow-up. Follow-up was performed by outpatient examination or telephone interview up to February 2020. Gastroscopy and portal vein CT examinations were performed within postoperative 3 to 6 months, and liver function, alpha fetoprotein and hepatobiliary B ultrasound were reexamined once every 6 months thereafter on patients to detect platelet count, coagulation and gastroesophageal varices. Measurement data with skewed distribution were expressed as n M (range). Count data were described as absolute numbers or percentages.n Results:(1) Surgical and postoperative situations: of the 68 patients, 30 underwent selective shunts, including 16 cases of splenectomy combined with coronary renal shunt, 7 cases of splenectomy combined with coronary caval shunt, 5 cases of distal splenorenal shunt, 1 case of inferior mesenteric vein renal shunt and 1 case of right gastroepiploic vein caval shunt. Selective gastric vein shunt was performed in 38 cases by rerouting the spontaneous porto-systemic shunt, including 33 cases by rerouting the spontaneous gastric-renal shunt, 3 cases by rerouting the spontaneous splenorenal shunt and splenectomy, 2 cases by rerouting the spontaneous splenorenal shunt only. Of 68 patients, no operative death was found. There was 1 case of intraperitoneal hemorrhage requiring reoperation for hemostasis, 1 case of intraperitoneal infection, 1 case of mild hepatic encephalopathy and 1 case of mild pulmonary embolism. (2) Follow-up: 68 patients were followed up for 18 months (range, 6-36 months). The liver function and the degree of ascites were improved obviously after operation. Portal vein thrombosis occurred in 5 patients, which were all in the group of selective gastric venous shunt via spontaneous gastric-renal shunt, with an incidence of 15.2%(5/33). Postoperative gastroscopy and CT portography showed the disappearance of gastrioesophageal varices in 31 cases, mild residue in 34 cases, recurrence in 3 cases including 1 case of rupture and rebleeding. Rebleeding was caused by anastomotic stenosis after right gastroepiploic vein caval shunt and the patient was cured after reoperation. Primary liver cancer occurred in 3 cases.Conclusion:Selective shunt procedures based on the portal hemodynamic features on patients can effectively prevent and cure gastroesophageal variceal bleeding, which can also improve liver function.