以血流动力学的变化为主要依据选择合理的术式是提高肝硬化门静脉高压症手术效果的关键。门静脉已成为流出道或门静脉入肝血量大量减少者，可行全门体静脉分流术；门静脉入肝血流量中等量减少，则几乎可施行各种分流手术和断流手术；门静脉入肝血流少量减少者可用脾切除断流术治疗。脾切除断流术后自由门静脉压力（FPP）值可以作为选择手术方式的依据。脾动脉结扎后FPP的变化最大，根据FPP下降的绝对值和幅度基本上能判断是行断流术或分流术，如下降不明显，表明肝内阻力高，需行分流或分流加断流术；如下降明显，FPP<22mmHg（1mmHg=0.133kPa）时，可行断流术。脾肾静脉分流加断流的联合手术有诸多优点，应作为治疗肝硬化PHT的首选术式。

Choice of shunting operation in portal hypertension. LUO Meng, WU Zhi-yong. Department of General Surgery，Renji Hospital，Shanghai Jiaotong University School of Medcine，Shanghai 200127，China Corresponding author: WU Zhi-yong, E-mail: zhengwk@online.sh.cn Abstract Hemodynamic assessment is conducive to the choice of operative approaches and plays a critical role in the surgical treatment in portal hypertension. Total portosystemic shunts are indicated if hemodynamic examinations disclose a total hepatofugal portal blood flow. When the portal perfusion is decreased moderately, even shunting operation or devascularization is suitable. When the portal perfusion is decreased slightly, splenectomy and devascularization is preferred. FPP after splenectomy and devascularization may be a gist of choice of surgical approaches in portal hypertention. The spleno-renal shunt operation or combined operation should be performed in the patients when FPP is over 22 mmHg（1mmHg=0.133kPa） after devascularization, otherwise the devascularization should be indicated. Combined procedures have the advantages of devascularization and shunting, and should be the choice of surgical procedure in portal hypertention.