门静脉左支血管转流术治疗小儿门静脉海绵样变性的疗效评估

doi:10.6040/j.issn.1671-7554.0.2016.191

摘要/Abstract

摘要： 目的评估门静脉左支血管转流术治疗小儿门静脉海绵样变性的疗效。方法对比15例门静脉海绵样变性患儿术前与术后门静脉压力、门静脉左支血流速度、门静脉左支直径、血细胞计数及食管胃底静脉曲张程度,分析影响手术有效性的因素。结果 15例患儿术前经门静脉彩色多普勒、CT门静脉造影均证实门静脉海绵样变性。术中门静脉造影示肝内门静脉分支通畅,将肝外门静脉属支与门静脉左支或脐静脉吻合行转流术,术后门静脉压力明显降低(P<0.01)。术后1周复查,门静脉多普勒示13例转流血管通畅,2例堵塞,手术成功率86.7%。2例手术失败患儿术后肝脏病理显示:1例慢性活动性肝炎,1例肝炎合并肝硬化。术后(33.3±10.9)个月,2例手术失败患儿经抗凝、抗血小板治疗转流血管均未再通,余13例转流血管通畅性良好。术后门静脉左支血流速度及直径明显增加(P<0.01);血细胞计数明显升高(P<0.05);食管胃底静脉曲张程度明显减轻(P<0.01)。肝脏病理、年龄均对手术有效性呈显著性影响(P<0.05)。结论门静脉左支血管转流术治疗门静脉海绵样变性疗效显著,因其较搭桥术操作简单、手术创伤小、术后患儿恢复快等优点,可成为治疗小儿门静脉海绵样变性的首选术式,且推荐在早期、肝脏无病变时施行手术

关键词: 门静脉左支血管转流术, 评估, 小儿, 疗效, 门静脉海绵样变性

Abstract: Objective To evaluate the therapeutic effect of Rex shunt in the treatment of cavernous transformation of portal vein(CTPV)in children. Methods A retrospective review of the preoperative, intraoperative and postoperative clinical data of 15 children with CTPV who underwent Rex shunt was conducted. Results Preoperative color-flow Doppler ultrasound and computed tomography angiography(CTA)portography confirmed CTPV in all patients. Intraoperative portography showed intrahepatic portal vein branches were patent. Extrahepatic portal vein branches were anastomosed to left portal vein(LPV)or umbilical vein in the Rex shunt and the portal pressure significantly decreased post-shunt(P<0.01). Doppler ultrasound showed the shunts were patent in 13 cases and obstructed in 2 cases 1 week postoperatively, thus the success rate of operation was 86.7% in total. Hepatic pathology indicated 1 of the 2 failure cases was chronic active hepatitis, and the other was hepatitis complicated with cirrhosis. During the follow-up of 33.3±10.9 months, the 2 failure cases did not restore patency by means of anticoagulant and antiplatelet treatment, while the shunts kept patent in the rest 13 cases. The blood flow velocity and diameter of LPV significantly increased after surgery 山东大学学报 (医学版)54卷7期 -王军锋,等.门静脉左支血管转流术治疗小儿门静脉海绵样变性的疗效评估 \=-(P<0.01). Postoperative blood count obviously increased(P<0.05). The degree of gastroesophageal varices were significantly mitigated postoperatively(P<0.01). Hepatic pathology and patients’ age had a significant influence on the operative effectiveness(P<0.05). Conclusion Rex shunt is effective in treating CTPV, and has advantages of simple operation, few operative trauma and rapid recovery over the bypass, thus it can be the first choice for the treatment of CTPV in children. It is suggested to be performed at the early stage without liver lesions.

Key words: Cavernous transformation of the portal vein, Evaluation, Rex shunt, Therapeutic effect, Children

中图分类号:

R726

王军锋,刘倩,孙小刚,李金良,徐加龙,吕其刚,马楠,王若义. 门静脉左支血管转流术治疗小儿门静脉海绵样变性的疗效评估[J]. 山东大学学报（医学版）, 2016, 54(7): 28-32.

WANG Junfeng, LIU Qian, SUN Xiaogang, LI Jinliang, XU Jialong, LÜ Qigang, MA Nan, WANG Ruoyi. Evaluation of the therapeutic effect of Rex shunt in the treatment of cavernous transformation of the portal vein in children[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(7): 28-32.

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