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