Yang Yang,Wen Zhe,Liang Qifeng.Influencing factors of vascular complications after Rex operation in children with portal hypertension[J].Journal of Clinical Pediatric Surgery,,22():37-43.[doi:10.3760/cma.j.cn101785-202108052-008]
Influencing factors of vascular complications after Rex operation in children with portal hypertension
- Keywords:
- Extrahepatic Portal Vein Obstruction; Hypertension; Portal; Surgical Procedures; Operative; Postoperative Complications; Embolism and Thrombosis; Surgical Stomas; Root Cause Analysis
- Abstract:
- ObjectiveTo explore the related factors and clinical implications of affecting the occurrence of vascular complications after Rex surgery (Meso-rex bypass).MethodsFrom October 2014 to April 2021,clinical data were retrospectively reviewed for 95 children of extrahepatic portal hypertension (EHPVO) undergoing an initial Rex operation.Postoperative vascular complications were defined as bypass vascular embolism and anastomotic stenosis.Two groups of vascular complication (n=14) and non-complication (n=81).Univariate analysis and Cox multivariate regression model analysis were utilized for determining the influencing factors of the occurrence of vascular complications after Rex.ResultsThere were anastomotic stenosis (n=10,10.5%) and vascular embolism (n=4,4.2%);Comparing parametric differences before and after operation:platelet count:[complication group (2.47±12.61)×109/L was lower than non-complication group (63.35±54.54)×109/L,the difference was statistically significant (t=8.677,P<0.001)];splenic length:[complication group (9.38±24.16) mm was shorter than non-complication group (23.20±20.65) mm,the difference was statistically significant (t=2.299,P=0.024)];spleen thickness:[complication group (1.95±7.11) mm was smaller than non-complication group (8.95±9.13) mm,the difference was statistically significant (t=2.782,P=0.007)].Based upon duration of illness,they were divided into two groups of ≤16 months (n=60) and >16 months (n=35).Vascular patency rates at 2 years post-operation were 93.3% (56/60) and 71.4% (25/35) and the difference was statistically significant (P=0.010).According to the choice of transplanted blood vessels,they were assigned into two groups of intra-abdominal vessels (n=13) and internal jugular veins (n=82).Vascular patency rates were 30.8%(4/13) and 93.9%(77/82) and the difference was statistically significant (P<0.001).According to portal vein pressure difference before and after operation,they were divided into two groups of portal vein pressure difference ≤2 mmHg (n=9) and >2 mmHg (n=86).Vascular patency rates at 2 years post-operation were 44.4%(4/9) and 89.5%(77/86) and the difference was statistically significant (P<0.001).Multivariate analysis of significant single factors revealed that duration of illness (P=0.036),portal pressure difference before and after operation (P=0.048) and type of transplanted blood vessel (P<0.001) were independent occurring factors of vascular complications after Rex.ConclusionRex surgery is an ideal treatment of extrahepatic portal hypertension in children.It can reconstruct blood flow into liver and effectively improve the symptoms of portal hypertension.Duration of illness,difference in portal pressure before and after surgery and type of transplanted blood vessels affect blood vessels after Rex.
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Memo
收稿日期:2021-08-22。
基金项目:广州市临床特色技术项目(2019TS58)
通讯作者:温哲,Email:wenzhe2005@163.com