Liu Zhenyin,Wen Zhe,Liu Tao,et al.Clinical application of balloon dilatation for anastomotic stenosis after meso-Rex bypass for cavernous transformation of the portal vein[J].Journal of Clinical Pediatric Surgery,,18():999-1003.[doi:10.3969/j.issn.1671-6353.2019.12.003]
Clinical application of balloon dilatation for anastomotic stenosis after meso-Rex bypass for cavernous transformation of the portal vein
- Keywords:
- Portal Cavernoma; Blood Vessels; Stomas; Balloon Dilatation
- CLC:
- R654.3;R657.3+4
- Abstract:
- Objective To explore clinical application of balloon dilatation for anastomotic stenosis after meso-Rex bypass (Rex) operation for cavernous transformation of the portal vein (CTPV).Methods Five CTPV patients developed anstomotic stenosis after Rex operation from November 2018 to April 2019.There were 2 boys and 3 girls with an age range of 1.9 to 11 years.Preoperative ultrasonography or computed tomograph (CT) showed stenosis in Rex shunt and the inner diameter of stenosis was 1 to 3.5 mm.Results Five patients underwent a total of 8 percutaneous transhepatic portal vein vasodilator interventions.Three of them underwent intervention once (2 successful,1 unsuccessful) and 1 twice (the first unsuccessful,the second successful).One patient had an extremet anastomotic stenosis of around 1 mm,the first and second operations failed to pass the guide wire through vascular stenosis and the third dilatation was successful with open laparotomy.The follow-up period was 6 to 9 months after dilatation.Ultrasonography showed that the diameter of anastomotic ostium expanded postoperatively.No complications occurred during 8 interventions.Conclusion Balloon dilatation is effective for anastomotic stenosis after Rex operation.And it contributes to improved treatment of CTPV in children.
References:
1 Weiss B,Shteyer E,Vivante A,et al.Etiology and long-term outcome of extrahepatic portal vein obstruction in children[J].World J Gastroenterol,2010,16(39):4968-4972.DOI:10.3748/wjg.v16.i39.4968.
2 Sharif K,Mckiernan P,de Ville DGJ.Mesoportal bypass for extrahepatic portal vein obstruction in children:close to a cure for most![J].J Pediatr Surg,2010,45(1):272-276.DOI:10.1016/j.jpedsurg.2009.08.019.
3 刘树立,李龙,侯文英,等.肠门分流(Rex手术)治疗肝外型门静脉高压的初步研究[J].临床小儿外科杂志,2009,8(6):13-16.DOI:10.3969/j.issn.1671-6353.2009.06.005. Liu SL,Li L,Hou WY,et al.Rex shunting for portal hypertension in children with cavernous transformation of portal vein[J].J Clin Ped Sur,2009,8(6):13-16.DOI:10.3969/j.issn.1671-6353.2009.06.005.
4 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.DOI:10.1097/01.sla.0000205827.73706.97.
5 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.DOI:10.1016/j.jpedsurg.2009.05.016.
6 Chiu B,Superina RA.Encephalopathy caused by a splenorenal shunt can be reversed by performing a mesenteric-to-left portal vein bypass[J].J Pediatr Surg,2006,41(6):1177-1179.DOI:10.1016/j.jpedsurg.2006.01.075.
7 Mack CL,Zelko FA,Lokar J,et al.Surgically restoring portal blood flow to the liver in children with primary extrahepatic portal vein thrombosis improves fluid neurocognitive ability[J].Pediatrics,2006,117(3):e405-e412.DOI:10.1542/peds.2005-1177.
8 Cwikiel W,Keussen I,Larsson L,et al.Interventional treatment of children with portal hypertension secondary to portal vein occlusion[J].Eur J Pediatr Surg,2003,13(5):312-318.DOI:10.1055/s-2003-43571.
9 Cortez AR,Kassam AF,Jenkins TM,et al.The role of surgical shunts in the treatment of pediatric portal hypertension[J].Surgery,2019,166(5):907-913.DOI:10.1016/j.surg.2019.05.009.
10 Patel N,Grieve A,Hiddema J,et al.Surgery for portal hypertension in children:A 12-year review[J].S Afr Med J,2017,107(10):12132.
11 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):13-19.DOI:10.1016/s0022-3468(00)80005-6.
12 Thornton RH,Kerlan RK,Gordon RL,et al.Percutaneous salvage of a failing rex shunt[J].J VascInterv Radiol,2005,16(3):399-402.DOI:10.1097/01.RVI.0000151143.49846.E0.
13 Lautz TB,Kim ST,Donaldson JS,et al.Outcomes of percutaneous interventions for managing stenosis after meso-Rex bypass for extrahepatic portal vein obstruction[J].J VascInterv Radiol,2012,23(3):377-383.DOI:10.1016/j.jvir.2011.11.030.
14 温哲,王哲,刘涛,等.颈内静脉搭桥Rex手术治疗小儿肝外门静脉梗阻的初步探讨[J].中华小儿外科杂志,2016,37(2):124-130.DOI:10.3760/cma.j.issn.0253-3006.2016.02.010. Wen Z,Wang Z,Liu T,et al.Preliminary experiences of Rex shunt for extrahepatic portal vein obstruction via a conduit of internal jugular vein[J].J Clin Ped Sur,2016,37(2):124-130.DOI:10.3760/cma.j.issn.0253-3006.2016.02.010.
15 张金山,李龙,刘树立,等.小儿肝外门静脉高压Rex术后门静脉高压复发的临床分析[J].中华小儿外科杂志,2015,36(12):894-897.DOI:10.3760/cma.j.issn.0253-3006.2015.12.004. Zhang JS,Li L,Liu SL,et al.Etiology and treatment for recurrent portal hypertension after Rex shunting in children[J].J Clin Ped Sur,2015,36(12):894-897.DOI:10.3760/cma.j.issn.0253-3006.2015.12.004.
16 Bhat R,Lautz TB,Superina RA,et al.Perioperative strategies and thrombophilia in children with extrahepatic portal vein obstruction undergoing the meso-Rex bypass[J].J Gastrointest Surg,2013,17(5):949-955.DOI:10.1007/s11605-013-2155-z.
Memo
收稿日期:2019-10-14。
基金项目:广东省省级科技计划项目（编号：2014A020212026）
通讯作者:张靖,Email:fejr@foxmail.com