Zhang Jinshan,Li Long.Efficacy of Rex shunt for portal cavernoma after hepaticojejunostomy in children with choledochal cyst[J].Journal of Clinical Pediatric Surgery,,18():1004-1008,1013.[doi:10.3969/j.issn.1671-6353.2019.12.004]
Efficacy of Rex shunt for portal cavernoma after hepaticojejunostomy in children with choledochal cyst
- Keywords:
- Rex Shunt; Choledochal Cyst; Portal Cavernoma; Hepaticojejunostomy; Extrahepatic Portal hypertension; Child
- CLC:
- R726;R575.7
- Abstract:
- Objective To explore the efficacy and feasibility of Rex shunt for extrahepatic portal venous obstruction after hepaticojejunostomy in children with choledochal cyst.Methods From August 2010 to November 2018,five children of upper gastrointestinal bleeding or splenomegaly were diagnosed as portal cavernoma,and Rex shunt was performed.All of them underwent hepaticojejunostomy for choledochal cyst prior to an onset of portal hypertension.Three children underwent gastro-portal bypass while another two had Roux-Y jejunal vein-portal bypass due to an unsuitable left gastric vein.The mean follow-up period was 46(2-100) months.Results Rex shunt was successfully performed in all patients.The average operative duration was 219 (180-375) min and the mean length of hospital stay 8(7-12) days.Postoperatively,one child undergoing Roux-Y jejunal vein-portal bypass suffered from rebleeding due to an atresia of bypass vein and conservative therapy was offered.The other four children had no rebleeding,bypass vein remained patent on postoperative ultrasound and the results of routine blood test (WBC,RBC,Plt & HGB) improved after Rex shunt.Splenic size decreased postoperatively (n=3) and postoperative splenic size expanded (n=2) undergoing Roux-Y jejunal vein-portal bypass.No esophageal varices occurred in three children after Rex shunt.One child of postoperative esophageal varices developed rebleeding and another one of esophageal varices was merely followed-up for 2 months.Conclusion Rex shunt is both safe and feasible for extra-hepatic portal hypertension after hepaticojejunostomy in children with choledochal cyst.And gastro-portal bypass is a reliable Rex shunt.
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Memo
收稿日期:2019-09-26。
基金项目:国家自然科学基金（编号：81770595）
通讯作者:李龙,Email:lilong23@126.com