Huang Zongwei,Gao Zhigang,Zhang Lifeng,et al.Clinical analysis of cavernous transformation of portal vein in children:a report of 18 cases[J].Journal of Clinical Pediatric Surgery,,19():810-815.[doi:10.3969/j.issn.1671-6353.2020.09.010]
Clinical analysis of cavernous transformation of portal vein in children:a report of 18 cases
- Keywords:
- Portal Vein/PA; Cavernous Transformation of Portal Vein/DI; Cavernous Transformation of Portal Vein/TH; Surgical Procedures; Operative/MT; Child
- CLC:
- R726.5;R657.3
- Abstract:
- Objective To explore the clinical characteristics and treatment modalities of cavernous transformation of portal vein (CTPV) in children. Methods The clinical data,surgical approaches and prognoses were analyzed retrospectively for 18 CTPV children from 2012 to 2018. Results All of them were operated successfully.Five of them underwent Rex shunting.The selected shunt vessels included superior mesenteric vein,gastric coronal vein,right gastric vein and the most significantly dilated collateral vessels of portal vein.One of them was reoperated due to gastrointestinal hemorrhage and hypersplenism.During re-operation,the cause was anastomotic stenosis.Another five children underwent Warren shunting.All of them recovered well without any postoperative complication.Four of them underwent proximal splenorenal shunting.However,one child was re-operated for recurrent gastrointestinal hemorrhage.Three of them underwent superior mesenteric vein-inferior vena cava shunting.Two children with postoperative hematemesis could be controlled by conservative measures. Conclusion CTPV should be diagnosed early in children.Appropriate treatment is essential for a decent prognosis.Surgical approach should be determined according to the status of disease and the vascular conditions of portal system.Rex shunt is recommended for CTPV in children.And Warren and proximal splenorenal shunts are also ideal.
References:
1 Yonem O,Bayraktar Y.Is portal vein cavernous transformation a component of congenital hepatic fibrosis?[J].World J Gastroenterol,2007,13(13):1928-1929.DOI:10.3748/wjg.v13.i13.1928.
2 王果,冯杰雄.小儿腹部外科学[M].北京:人民卫生出版社,2011:732-734.Wang G,Feng JX.Pediatric Abdominal Surgery[M].Beijing:People’s Health Publishing House,2011:732-734.
3 Shinohara T,Ando H,Watanabe Y,et al.Extrahepatic portal vein morphology in children with extrahepatic portal hypertension assessed by 3-dimensional computed tomographic portography:a new etiology of extrahepatic portal hypertension[J].J Pediatr Surg,2006,41(4):812-816.DOI:10.1016/j.jpedsurg.2005.12.027.
4 Guimaraes H,Castelo L,Guimaraes J,et al.Does umbilical vein catheterization to exchange transfusion lead to portal vein thrombosis?[J].Eur J Pediatr,1998,157(6):461-463.DOI:10.1007/s004310050853.
5 Kathemann S,Lainka E,Ludwig JM,et al.Imaging of the intrahepatic portal vein in children with extrahepatic portal vein thrombosis-comparison of magnetic resonance imaging and retrograde portography[J].J Pediatr Surg,2019,54(8):1686-1690.DOI:10.1016/j.jpedsurg.2018.10.049.
6 Monroe EJ,Speir EJ,Hawkins CM,et al.Transsplenic splenoportography and portal venous interventions in pediatric patients[J].Pediatric Radiology,2018,48(10):1441-1450.DOI:10.1007/s00247-018-4157-1.
7 Chennapragada SM,Lord DJ,Wong CKF,et al.Abstract No.195:Transsplenic splenoportography in paediatric portal hypertension:a safe and useful tool[J].Journal of Vascular & Interventional Radiology,2008,19(2):S74.DOI:10.1016/j.jvir.2007.12.217.
8 Menon P,Rao KL,Bhattacharya A,et al.Extrahepatic portal hypertension:quality of life and somatic growth after surgery[J].Eur J Pediatr Surg,2005,15(2):82-87.DOI:10.1055/s-2004-830341.
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):13-19.DOI:10.1016/s0022-3468(00)80005-6.
10 Zhang JS,Li L,Cheng W.A new procedure for the treatment of extrahepatic portal hypertension in children:portal cavernoma-rex shunt with interposition of grafted portal vessel[J].J Am Coll Surg,2016,222(6):e71-e76.DOI:10.1016/j.jamcollsurg.2016.03.020.
11 Zhao H,Tsauo J,Zhang X,et al.Regarding "The optimal procedure of modified Rex shunt for the treatment of extrahepatic portal hypertension in children"[J].J Vasc Surg Venous Lymphat Disord,2018,6(3):421-422.DOI:10.1016/j.jvsv.2017.11.008.
12 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.
13 张金山,李龙.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.Etiology and treatment for recurrent portal hypertension after Rex shunting in children[J].Chin J Pediatr Surge,2015,36(12):894-897.DOI:10.3760/cma.j.issn.0253-3006.2015.12.004.
14 Zhang W,Shao GR,Zhang Y,et al.Partial splenectomy and use of splenic vein as an autograft for meso-Rex bypass:a clinicaI observational study[J].Med Sci Monit,2014,20:2235-2242.DOI:1012659/MSM 892482.
15 孔艳霞,张大.分流手术治疗门脉海绵样变8例临床分析[J].临床小儿外科杂志,2015,14(5):414-416.DOI:10.3969/j.issn.1671-6353.2015.05.019.Kong YX,Zhang D.Shunting procedures for cavernous transformation of portal vein:a report of 8 cases[J].J Clin Ped Sur,2015,14(5):414-416.DOI:10.3969/j.issn.1671-6353.2015.05.019.
16 Wang RY,Wang JF,Sun XG,et al.Evaluation of Rex shunt on cavernous transformation of the portal vein in children[J].World Journal of Surgery,2017,41(4):1134-1142.DOI:10.1007/s00268-016-3838-x.
17 张金山,李龙.Rex手术治疗小儿肝外门静脉高压的应用进展[J].中华小儿外科杂志,2017,38(8):636-640.DOI:10.3760/cma.j.issn.0253-3006.2017.08.018.Zhang JS,Li L.Recent advances of Rex shunt for extra-hepatic portal venous obstruction[J].Chin J Pediatr Surg,2017,38(8):636-640.DOI:10.3760/cma.j.issn.0253-3006.2017.08.018.
18 Sretenovic AL,Peri?i? V,Krsti? Z,et al.Warren shunt combined with partial splenectomy for children with extrahepatic portal hypertension,massive splenomegaly and severe hypersplenism[J].Surgery Today,2013,43(5):521-525.DOI:10.1007/s00595-012-0405-4.
19 张金山,侯文英,李龙.Warren手术治疗小儿门脉高压症50例分析[J].临床小儿外科杂志,2014,13(1):26-29.DOI:10.3969/j.issn.1671-6353.2014.01.009.Zhang JS,Hou WY,Li L.Warren’s operation in the treatment of portal hypertension in children:a report of 50 cases[J].J Clin Ped Sur,2014,13(1):26-29.DOI:10.3969/j.issn.1671-6353.2014.01.009.
20 Rao KL,Goyal A,Menon P,et al.Extrahepatic portal hypertension in children:observations on three surgical procedures[J].Pediatric Surgery International,2004,20(9):679-684.DOI:10.1007/s00383-004-1272-x.
21 Zhang JS,Li L,Hou WY,et al.Spleen-preserving proximal splenic-left intrahepatic portal shunt for the treatment of extrahepatic portal hypertension in children[J].J Pediatr Surg,2015,50(6):1072-1075.DOI:10.1016/j.jpedsurg.2015.02.048.
Memo
收稿日期:2019-05-13。
基金项目:2017年浙江省医药卫生科研项目（编号：2017KY441）
通讯作者:高志刚,Email:ebwk@zju.edu.cn