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.

参考文献

[1] Bayraktar Y, Balkanci F, Kayhan B, et al. Congenital hepatic fibrosis associated with cavernous transformation of the portal vein[J]. Hepatogastroenterology, 1997, 44(18): 1588-1594.
[2] Sarin SK, Lahoti D, Saxena SP, et al. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients[J]. Hepatology, 1992, 16(6): 1343-1349.
[3] Triger DR. Extra hepatic portal venous obstruction[J]. Gut, 1987, 28(10): 1193-1197.
[4] 张金哲. 肝前性门静脉高压症[M] //黄廷庭.门静脉高压症外科学. 北京: 人民卫生出版社, 2002: 623-634.
[5] Lautz TB, Keys LA, Melvin JC, et al. Advantages of the meso-Rex bypass compared with portosystemic shunts in the management of extrahepatic portal vein obstruction in children[J]. J Am Coll Surg, 2013, 216(1): 83-89.
[6] Superina R, Bambini DA, Lokar J, et al. Correction of extrahepatic portal vein thrombosis by the mesenteric to left portal vein bypass[J]. Ann Surg, 2006, 243(4): 515-521.
[7] Dasgupta R, Roberts E, Superina RA, et al. Effectiveness of Rex shunt in the treatment of portal hypertension[J]. J Pediatr Surg, 2006, 41(1): 108-112.
[8] Lautz TB, Sundaram SS, Whitington PF, et al. Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass[J]. J Pediatr Surg, 2009, 44(11): 2067-2070.
[9] Bambini DA, Superina R, Almond PS, et al. Experience with the Rex shunt(mesenterico-left portal bypass)in children with extrahepatic portal hypertension[J]. J Pediatr Surg, 2000, 35(1): 13-18.
[10] Sharif K, McKiernan P, de Ville de Goyet J. Mesoportal bypass for extrahepatic portal vein obstruction in children: close to a cure for most[J]. J Pediatr Surg, 2010, 45(1): 272-276.
[11] Tajiri T, Yoshida H, Obara K, et al. General rules for recording endoscopic findings of esophagogastric varices(2nd edition)[J]. Dig Endosc, 2010, 22(1): 1-9.
[12] de Ville de Goyet J, Gibbs P, Clapuyt P, et al. Original extrahilar approach for hepatic portal revascularization and relief of extrahepatic portal hypertension related to later portal vein thrombosis after pediatric liver transplantation. Long term results[J]. Transplantation, 1996, 62(1): 71-75.
[13] Li JL, Chen WX, Xu CX, et al. Treatment of portal hypertension from portal vein cavernoma with the meso-Rex bypass[J]. Chin Med J(Engl), 2013, 126(5): 971-973.
[14] de Ville de Goyet J, Alberti D, Clapuyt P, et al. Direct bypassing of extrahepatic portal venous obstruction in children: a new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension[J]. J Pediatr Surg, 1998, 33(4): 597-601.
[15] de Ville de Goyet J, Martinet JP, Lacrosse M, et al. Mesenterico-left intrahepatic portal vein shunt: original technique to treat symptomatic extrahepatic portal hypertension[J]. Acta Gastroenterol Belg, 1998, 61(1): 13-16.
[16] de Ville de Goyet J, Alberti D, Falchetti D, et al. Treatment of extrahepatic portal hypertension in children by mesenteric-to-left portal vein bypass: a new physiological procedure[J]. Eur J Surg, 1999, 165(8): 777-781.
[17] Stenger AM, Malago M, Nolkemper D, et al. Mesentericoportal Rex-shunt as a treatment for extrahepatic portal vein thrombosis[J]. Chirurg, 1999, 70(4): 476-479.
[18] Ates O, Hakguder G, Olguner M, et al. Extrahepatic portal hypertension treated by anastomosing inferior mesenteric vein to left portal vein at Rex recessus[J]. J Pediatr Surg, 2003, 38(10): 10-11.
[19] Chiu B, Pillai SB, Sandler AD, et al. Experience with alternate sources of venous inflow in the meso-Rex bypass operation: the coronary and splenic veins[J]. J Pediatr Surg, 2007, 42(7): 1199-1202.
[20] 王若义, 秦虹, 刘倩, 等. Rex-bypass shunt联合贲门周围血管离断治疗小儿肝前性门静脉高压[J]. 中华小儿外科杂志, 2015, 36(4): 273-277.
[21] Fuchs J, Warmann S, Kardorff R, et al. Mesenterico-left portal vein bypass in children with congenital extrahepatic portal vein thrombosis: a unique curative approach[J]. J Pediatr Gastroenterol Nutr, 2003, 36(2): 213-216.
[22] Luoto T, Pakarinen M, Mattila I, et al. Mesoportal bypass using a constructed saphenous vein graft for extrahepatic portal vein obstruction-technique, feasibility, and outcomes[J]. J Pediatr Surg, 2012, 47(4): 688-693.
[23] Alberti D, Colusso M, Cheli M, et al. Results of a stepwise approach to extrahepatic portal vein obstruction in children[J]. J Pediatr Gastroenterol Nutr, 2013, 57(5): 619-626.

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