Wang Yi,Yao Zhiguang,Liu Yingsong,et al.Clinical efficacies of Rex shunt (internal jugular vein) for pediatric prehepatic portal hypertension[J].Journal of Clinical Pediatric Surgery,,18():1018-1022.[doi:10.3969/j.issn.1671-6353.2019.12.007]
Clinical efficacies of Rex shunt (internal jugular vein) for pediatric prehepatic portal hypertension
- Keywords:
- Portasystemic Shunt; Transjugular Intrahepatic; Portal Cavernoma; Surgical Procedures; Operative; Treatment Outcome
- CLC:
- R726;R657.3+4
- Abstract:
- Objective To explore the efficacies of Rex shunt for children with cavernous transformation of portal vein (CTPV).Methods 7 boys and 5 girls with CTPV aged from 89 to 180 months were recruited between May 2015 and May 2018. There were recurrent upper gastrointestinal (GI) hemorrhage (n=10) and hypersplenism (n=12). Upper GI radiography (UGIR) indicated esophageal-gastric varices (EGV) and ultrasonograph (Us) hinted at CTPV in all children. After Rex shunt,the follow-up period was 12 to 24 months. Results The median operative duration was 420(380-480) min and the volume of intraoperative hemorrhage 30 to 150 mL without a necessity for blood transfusion. The mean pressure of inferior mesenteric vein was (32.5±3.7)(24-37) cm H2O before shunting and (23.5±4.7)(17-34) cm H2O after shunting. And the difference was statistically significant (t=5.19,P=0.001). The preoperative and postoperative counts of leucocytes were (2.1±0.6)×1012g/L and (4.4±2.3)×1012g/L. And the difference was statistically significant (t=3.29,P=0.003). Hemoglobin was (65.2±19.5) g/L and (101.2±13.9) g/L before and after operation respectively and the difference was statistically significant (t=5.70,P=0.001). The count of platelet was (70.5±33.1)×109/L and (70.5±33.1)×109/L before and after operation respectively and the difference was statistically significant (t=4.21,P=0.001). The length and thickness of spleen were smaller at 12 months post-operation than those pre-operation. The difference was statistically significant (P=0.001). No postoperative complications occurred during follow-ups. Conclusion Rex shunt is feasible, safe and effective for pediatric CTPV.
References:
1 Senzolo M,Tibbah J,Cbolongitas E,et al.Transjuguhr intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation[J].Aliment Pharmacol Ther,2006,23(6):767-775.DOI:10.1111/j.1365-2036.2006.02820.x.
2 刘斐,王哲,温哲.Rex分流术治疗小儿肝前性门静脉高压症5例临床分析[J].中华肝胆外科杂志,2016,22(2):73-77.DOI:10.3760/cma.j.issn.1007-8118.2016.02.001. Liu F,Wang Z,Wen Z.Rex shunt in pediatric prehepatic portal hypertension:a clinical analysis of 5 cases[J].Chin J Hepatobiliary Surg,2016,22(2):73-77.DOI:10.3760/cma.j.issn.1007-8118.2016.02.001.
3 de Ville de Goyet J,Clapuyt P,Otte JB.Extrahilar mesentericoleft portal shunt to relieve extrahepatic portal hypertension after partial liver transplant[J].Transplantation,1992,53(1):231-232.
4 Dai J,Qi X,Li H et al.Role of D-dimer in the development of portal vein thrombosis in liver cirrhosis:A Meta-analysis[J].Saudi J Gastroenterology,2015,21(3):165-174.DOI:10.4103/1319-3767.157567.
5 Hneider BL,de Ville de Goyet J,Leung DH,et al.Primary prophylaxis of variceal bleeding in children and the role of MesoRex bypass:Summary of the Baveno VI Pediatric Satellite Symposium[J].Hepatology,2016,63(4):1368-1380.DOI:10.1002/hep.28153.
6 张金山,李龙.Rex手术治疗胆总管囊肿术后门静脉海绵样变的应用研究[J].临床小儿外科杂志,2019,18(12):1004-1008.DOI:10.3969/j.issn.1671-6353.2019.12.004. Zhang JS,Li L.Efficacy of Rex shunt for portal cavernoma after hepaticojejunostomy in children with choledochal cyst[J].J Clin Ped Sur,2019,18(12):1004-1008.DOI:10.3969/j.issn.1671-6353.2019.12.004.
7 温哲,张宾宾.儿童肝前性门静脉高压的术前评估及手术治疗[J].临床小儿外科杂志,2019,18(12):994-998.DOI:10.3969/j.issn.1671-6353.2019.12.002. Wen Z,Zhang BB.Preoperative assessments and operations for prehepatic portal hypertension in children[J].J Clin Ped Sur,2019,18(12):994-998.DOI:10.3969/j.issn.1671-6353.2019.12.002.
8 Luo X,Nie L,Zhou B.Transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension in noncirrhotic patients with portal cavernoma[J].Gastroenterol Res Pract,2014,2014:659-726.DOI:10.1155/2014/659726.
9 万岐江,候蔚蔚,王忠敏.经颈静脉肝内门体静脉分流术治疗门静脉高压的临床研究现状与进展[J].中国介入影像与治疗学,2015,12(3):186-189.DOI:10.13929/j.1672-8475.2015.03.014. Wan QJ,Hou WW,Wang ZM.Current status and progresses of clinical research of transjugular intrahepatic portosystemic shunt in treatment of portal hypertension[J].Chin J Interv Imaging,2015,12(3):186-189.DOI:10.13929/j.1672-8475.2015.03.014.
10 张金山,李龙,刘树立,等.小儿肝外门脉高压Rex术后门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].Chin J Ped Sur,2015,36(12):894-897.DOI:10.3760/cma.j.issn.0253-3006.2015.12.004.
11 Kim HB,Pomposelli JJ,Lillehei CW,et al.Mesogonadal shunts for extrahepatic portal vein thrombosis and variceal hemorrhage[J].Liver Transpl,2005,11(11):1389-1394.DOI:10.1002/lt.20487.
12 Di Francesco F,Grimaldi C,de Ville de Goyet J.Meso-Rex bypass-a procedure to cure prehepatic portal hypertension:the insight and the inside[J].J Am Coll Surg,2014,218(2):23-36.DOI:10.1016/j.jamcollsurg.2013.10.024.
13 刘树立,李龙,侯文丽,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 WL,et al.Rex shunt 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.
14 Rivera J,Fusaro F,de Magnee C,et al.Meso-Rex shunt for immediate portal revascularization in pediatric liver transplantation:first report[J].Pediatr Transplant,2012,16(6):235-237.DOI:10.1111/j.1399.3046.2011.01576.X.
Memo
收稿日期:2019-09-24。
基金项目:东莞市社会科技发展重点项目（编号：201950715028167）
通讯作者:马达,Email:804103064@qq.com