目的探讨保留脾脏、远端脾静脉肾静脉分流手术治疗肝外型门脉高压的效果。方法本组手术患儿15例,术前经多普勒超声检查门静脉主干呈海绵窦样改变。术中首先经小肠系膜Ⅲ级静脉和脾静脉分支行静脉压力测定及造影。然后将胰腺上下缘及背侧游离;将胰腺内走行的脾静脉游离,结扎切断与胰腺之间的细小分支,远端至脾静脉与肠系膜上静脉或肠系膜下静脉汇合处,近端至脾门;最后将脾静脉距肠系膜上或下静脉0.5cm处切断,闭合肠系膜上静脉侧断端,将脾静脉与左肾静脉端一侧吻合;同时结扎胃冠状静脉、胃左静脉和胃网膜左静脉而保留胃短血管。结果15例患儿实施远端脾-肾分流手术,手术时间平均3.5h,手术失血10～30ml;无需输血者。分流前肠系膜上静脉和脾静脉压力平均值分别为28.4cmH2O和28.1cmH2O,分流后平均值分别为24.7cmH2O和12.6cmH2O,脾静脉压力明显降低(P<0.01)。分流后脾脏缩小,被膜皱缩。2例手术后患儿出现乳糜腹,保守治疗1个月后自然消失。患儿随诊6个月～2年无再发消化道出血者,脾脏大小均回缩。血红蛋白、白细胞、血小板均在正常水平。超声多普勒检查,脾肾静脉吻合口通畅。结论远端脾静脉-肾静脉分流术是治疗小儿肝外型门静脉高压的有效途径之一,具有保留脾脏,贲门胃底血液可通过胃短动脉流向脾静脉使该区域保 Objective To investigate the effect of preserving splenic and distal splenic vein shunt on extrahepatic portal hypertension. Methods 15 cases of children in this group of surgery, preoperative Doppler ultrasound examination of the main portal vein was cavernous sinusoid change. Intraoperative venous pressure measurement and angiography were performed firstly through the small intestinal mesenteric grade III and splenic vein branches. Then the upper and lower edge of the pancreas and dorsal free; walking in the pancreas free splenic vein, ligation and cut off the small branch between the pancreas, distal to splenic vein and superior mesenteric vein or inferior mesenteric vein confluence, proximal to splenic ; Finally, the splenic vein was cut off 0.5 cm above or below the superior mesenteric vein to close the superior mesenteric vein, and the splenic vein was anastomosed with the left renal vein. At the same time, the gastric coronary vein, gastric left venous and gastric left Veins and keep the stomach short blood vessels. Results 15 cases of children performed distal splenic-renal shunt operation, the average operation time 3.5h, blood loss 10 ~ 30ml; no blood transfusion. The average values ​​of the superior mesenteric vein and splenic vein before shunt were 28.4cmH2O and 28.1cmH2O, respectively, and the average values ​​after shunt were 24.7cmH2O and 12.6cmH2O, respectively. The pressure of splenic vein was significantly decreased (P <0.01). Shunt narrowing of the spleen, capsule shrinkage. 2 cases of chylous abdomen in children after surgery, conservative treatment disappeared after 1 month. Children followed up for 6 months to 2 years without recurrent gastrointestinal bleeding, spleen size were retracted. Hemoglobin, white blood cells, platelets are at normal levels. Doppler ultrasound, splenic renal vein anastomotic patency. Conclusion distal splenic vein - renal vein shunt is an effective way to treat pediatric extrahepatic portal hypertension, with retention of the spleen, gastric cardia gastric fundus blood flow through the spleen veins to the area