Zhang Jinshan,Li Long.Recent advances in surgery for portal hypertension in children[J].Journal of Clinical Pediatric Surgery,2019,18(12):989-993.[doi:10.3969/j.issn.1671-6353.2019.12.001]
小儿门静脉高压手术治疗新进展
- Title:
- Recent advances in surgery for portal hypertension in children
- Keywords:
- Hypertension; Portal; Surgical Procedures; Operative; Child
- 分类号:
- R726.1;R657.3+4;R544.1
- 摘要:
- 门静脉高压是导致小儿上消化道出血的重要原因之一,常见的小儿门静脉高压分为肝内型门静脉高压和肝外型门静脉高压。对于门静脉高压引发的上消化道出血通常首选止血、输血等保守治疗,但保守治疗通常仅对当时的症状有所缓解,并不能改变门静脉高压状态,因此上消化道出血复发是不可避免的。为了预防和治疗上消化道出血和脾功能亢进,手术是唯一有效的治疗方法。但有不少小儿外科医生对其发病机制和治疗原则不甚清楚。因此,本文总结小儿门静脉高压的手术治疗经验和既往研究,对其治疗的最新进展进行评价。
- Abstract:
- Portal hypertension is one of the important causes of upper gastrointestinal hemorrhage in children.Portal hypertension generally involves the intra-and extra-hepatic portal hypertension in children.For the upper gastrointestinal hemorrhage,conservative treatment (such as hemostasis and blood transfusion) is usually the first choice,but conservative treatment fails torelivingthe portal hypertension.In order to treat portal hypertension effectively,operation is the only method.However,many pediatric surgeons are still unclear about its pathogenesis and treatment principles.Therefore,we summarize our experience and previous studies of surgical treatment for portal hypertension in children,and evaluate the latest progress in surgical treatment.
参考文献/References:
1 Peter L,Dadhich SK,Yachha SK,et al.Clinical and laboratory differentiation of cirrhosis and extrahepatic portal venous obstruction in children[J].J Gastroenterol Hepatal,2003,18(2):185-189.DOI:10.1046/j.1440-1746.2003.02943.x.
2 李振东,于增文,赵莉.小儿门脉高压症肝内、肝外形外科治疗的比较[J].中华小儿外科杂志,2001,22(6):349-351.DOI:10.3760/cma.j.issn.0253-3006.2001.06.011. Li ZD,Yu ZW,Zhao L.Comparative study of surgical treatment between intra-and extrahepatic portal hypertension in children[J].Chin J Pediatr Surg,2001,22(6):349-351.DOI:10.3760/cma.j.issn.0253-3006.2001.06.011.
3 Arora NK,Lodha R,Gulati S,et al.Portal hypertension in north Indian children[J].Indian J Pediatr,1998,65(4):85-91.DOI:10.1007/BF02730901.
4 Simon EG,Joseph AJ,George B,et al.Aetiology of paediatric portal hypertension-experience of a tertiary care centre in south India[J].Trop Doct,2009,39(1):42-44.DOI:10.1258/td.2008.080050.
5 El-Hamid N,Taylor RM,Marinello D,et al.Aetiology and management of extrahepatic portal vein obstruction in children:King’s College Hospital experience[J].J Pediatr Gastroenterol & Nutr,2008,47(5):630-634.DOI:10.1097/MPG.0b013e31817b6eea.
6 Belli L,Puttini M,Marni A.Extrahepatic portal obstruction:clinical experience and surgical treatment in 105 patients[J].J Cardiovasc Surg,1980,21(4):439-448.
7 Botha JF,Campos BD,Grant WJ,et al.Portosystemic shunts in children:a 15-year experience[J].J Am Coll Surg,2004,199(2):179-185.DOI:10.1016/j.jamcollsurg.2004.03.024.
8 Jalan R,Hayes PC.UK guidelines on the management of varicealhaemorrhage in cirrhotic patients[J].Gut,2000,46:1-15.DOI:10.1136/gut.46.suppl_3.iii1.
9 张金山,李龙,侯文英,等.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,Li L,Hou WY,et al.The application and results of Warren’s operation in the treatment of portal hypertension in children:a 13-year experience[J].J Clin Pediatr Surg,2014,13(1):26-29.DOI:10.3969/j.issn.1671-6353.2014.01.009.
10 De Ville de Goyet J,Clapuyt P,Otte JB.Extrahilarmesenterico-left portal shunt to relieve extrahepatic portal hypertension after partial liver transplant[J].Transplantation,1992,53(1):231-232.
11 De Ville de Goyet J,Alberti D,Falchetti D,et al.Treatment of extrahepatic portal hypertension in children by mesenteric-to-left portal vein bypass:a new physiological procedure[J].Eur J Surg,1999,165(8):777-781.DOI:10.1080/11024159950189573.
12 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):482-486.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):482-486.DOI:10.3760/cma.j.issn.0253-3006.2017.08.018.
13 Fuchs J,Warmann S,Kardorff R,et al.Mesenterico-left portal vein bypass in children with congenital extrahepatic portal vein thrombosis:a unique curative approach[J].J Pediatr Gastroenterol Nutr,2003,36(2):213-216.DOI:10.1097/00005176-200302000-00010.
14 张金山,李龙.改良Rex手术治疗小儿肝外门脉高压的疗效及最佳方法探讨[J].中华小儿外科杂志,2017,38(8):27-32.DOI:10.3760/cma.j.issn.0253-3006.2017.08.007. Zhang JS,Li L.Optimal procedure of modified Rex shunt for extrahepatic portal hypertension in children[J].Chin J Pediatr Surg,2017,38(8):27-32.DOI:10.3760/cma.j.issn.0253-3006.2017.08.007.
15 Lautz TB,Keys LA,Melvin JC,et al.Advantags of the meso-Rex bypass compared with portosystemic shunts in the management of extrahepatic portal vein obstruction in children[J].J Am Coll Surg,2013,216(1):83-89.DOI:10.1016/j.jamcollsurg.2012.09.013.
16 Ates O,Hakguder G,Olguner M,et al.Mesenterico-left portal bypass for variceal bleeding owing to extrahepatic portal hypertension caused by portal vein thrombosis[J].J Pediatr Surg,2006,41(7):1259-1263.DOI:10.1016/j.jpedsurg.2006.03.043.
17 Dasgupta R,Roberts E,Superina RA,et al.Effectiveness of Rex bypass in the treatment of portal hypertension[J].J Pediatr Surg,2006,41(1):108-112.DOI:10.1016/j.jpedsurg.2005.10.059.
18 Gibelli NE,Tannuri AC,Pinho-Apezzato ML,et al.Extrahepatic portal vein thrombosis after umbilical catheterization:is it a good choice for Rex bypass?[J] J Pediatr Surg,2011,46(1):214-216.DOI:10.1016/j.jpedsurg.2010.09.091.
19 Bhat R,Lautz TB,Superina RA,et al.Perioperative strategies and thrombophilia in children with extrahepatic portal vein obstruction undergoing the meso-rexbypass[J].J Gastrointest Surg,2013,17(5):949-955.DOI:10.1007/s11605-013-2155-z.
20 Sharif K,Mckiernan P,De Ville de Goyet J.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.
21 Kitchens CS,Weidner MH,Lottenberg R.Chronic oral anticoagulant therapy for extrahepatic visceral thrombosis is safe[J].J Thromb Thrombolysis,2007,23(3):223-228.DOI:10.1007/s11239-006-9017-4.
22 Silva-Junior G,Turon F,Hernandez-Gea V,et al.Unexpected disappearance of portal cavernoma on long-term anticoagulation[J].J Hepatol,2014,61(2):446-448.DOI:10.1016/j.jhep.2014.04.002.
23 Khanna R,Sarin SK.Non-cirrhotic portal hypertension:diagnosis and management[J].J Hepatol,2014,60(2):421-441.DOI:10.1016/j.jhep.2013.08.013.
24 Zhang JS,Li L,Cheng W.Postoperative enlargement and prognostic effects of portal venous bypass grafts in children undergoing Rex shunt[J].J Vasc Surg Venous Lymphat Disord,2018,6(6):742-747.DOI:10.1016/j.jvsv.2018.01.020.
25 Chin AC,Thow F,Superina RA.Previous portal hypertension surgery negatively affects results of mesenteric to left portal vein bypass[J].J Pediatr Surg,2008,43(1):114-119.DOI:10.1016/j.jpedsurg.2007.09.032.
26 张金山,李龙.Rex术后再发生上消化道出血的治疗策略探讨[J].中华小儿外科杂志,2017,38(9):678-683.DOI:10.3760/cma.j.issn.0253-3006.2017.09.007. Zhang JS,Li L.Therapeutic strategies for recurrent upper gastrointestinal hemorrhage in children undergoing Rex shunting[J].Chin J Pediatr Surg,2017,38(9):678-683.DOI:10.3760/cma.j.issn.0253-3006.2017.09.007.
27 Li L,Zhang JS,Zhen C,et al.Portal-to-right portal vein bypass for extrahepatic portal vein obstruction[J].J Pediatr Surg,2018,53(7):1403-1407.DOI:10.1016/j.jpedsurg.2017.10.059.
28 彭宇明,司中州,袁妙贤,等.儿童肝移植20例诊治分析[J].临床小儿外科杂志,2019,18(8):681-685.DOI:10.3969/j.issn.1671-6353.2019.08.013. Peng YM,Si ZZ,Yuan MX,et al.Diagnoses and treatments of hepatic transplantation in 20 children[J].J Clin Ped Sur,2019,18(8):681-685.DOI:10.3969/j.issn.1671-6353.2019.08.013.
相似文献/References:
[1]王鹏高翟波罗淑颖.婴幼儿室间隔缺损合并肺动脉高压的外科治疗[J].临床小儿外科杂志,2010,9(03):0.
[2]麻晓鹏,王涛,祖莹,等.肺动脉平滑肌细胞钙含量与先心病肺动脉高压的关联性研究[J].临床小儿外科杂志,2008,7(01):9.
[3]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(01):26.
[4]舒仕瑜,张智恩,陈功,等.先天性膈疝患儿手术后近期肺功能的临床观察[J].临床小儿外科杂志,2017,16(05):444.
[5]卢圣勋,罗俊辉,邢亚闯,等.东莨菪碱改善先天性室间隔缺损合并肺动脉高压患儿体外循环术后氧合指数的效果探讨[J].临床小儿外科杂志,2017,16(05):473.
[6]尹强,彭宇明,季春宜,等.以肺动脉高压为首发症状的先天性肝内门体分流Ⅴ型静脉导管未闭诊疗经验[J].临床小儿外科杂志,2022,21(03):283.[doi:10.3760/cma.j.cn101785-201911014-015]
Yin Qiang,Peng Yuming,Ji Chunyi,et al.Type V Congenital intrahepatic portosystemic shunt-patent ductus venosus with pulmonary hypertension as the first symptom: one case report with a literature review[J].Journal of Clinical Pediatric Surgery,2022,21(12):283.[doi:10.3760/cma.j.cn101785-201911014-015]
[7]张金山,李龙.门静脉通畅状态对门静脉血流动力学和门静脉血管病理改变的影响研究[J].临床小儿外科杂志,2022,21(10):980.[doi:10.3760/cma.j.cn101785-202105061-014]
Zhang Jinshan,Li Long.Relationship between portal vein patency and changes of portal hemodynamics and portal venous pathology[J].Journal of Clinical Pediatric Surgery,2022,21(12):980.[doi:10.3760/cma.j.cn101785-202105061-014]
[8]刘百慧,解鲁璐,姚伟,等.联合肝脏离断和门静脉结扎二步肝切除术治疗儿童巨大肝母细胞瘤[J].临床小儿外科杂志,2023,22(12):1119.[doi:10.3760/cma.j.cn101785-202309028-005]
Liu Baihui,Xie Lulu,Yao Wei,et al.Application of associating liver partition and portal vein ligation during two-stage hepatectomy for massive hepatoblastoma[J].Journal of Clinical Pediatric Surgery,2023,22(12):1119.[doi:10.3760/cma.j.cn101785-202309028-005]
[9]于增文 李索林 李英超 徐伟立 时保军. 腹腔镜脾切除联合胃食管周围血管离断术治疗小儿门静脉高压症[J].临床小儿外科杂志,2011,10(04):267.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):267.
[10]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.[doi:10.3969/j.issn.1671-6353.2019.12.002]
Wen Zhe,Zhang Binbin.Preoperative assessments and operations for prehepatic portal hypertension in children[J].Journal of Clinical Pediatric Surgery,2019,18(12):994.[doi:10.3969/j.issn.1671-6353.2019.12.002]
[11]田琳欢,李索林,刘林,等.腹腔镜脾大部分切除联合选择性贲门周围血管离断术治疗儿童肝内型门静脉高压症[J].临床小儿外科杂志,2019,18(12):1009.[doi:10.3969/j.issn.1671-6353.2019.12.005]
Tian Linhuan,Li Suolin,Liu Lin,et al.Laparoscopic subtotal splenectomy plus selective periesophagogastric devascularization for intrahepatic portal hypertension in children[J].Journal of Clinical Pediatric Surgery,2019,18(12):1009.[doi:10.3969/j.issn.1671-6353.2019.12.005]
[12]孙蕊,李龙.儿童门静脉海绵样变性的外科手术治疗研究进展[J].临床小儿外科杂志,2020,19(12):1145.[doi:10.3969/j.issn.1671-6353.2020.12.016]
Sun Rui,Li Long.Research advances of surgery for cavernous transformation of portal vein in children[J].Journal of Clinical Pediatric Surgery,2020,19(12):1145.[doi:10.3969/j.issn.1671-6353.2020.12.016]
[13]杨阳,温哲,梁奇峰.儿童门静脉高压Rex手术后发生血管并发症的相关因素研究[J].临床小儿外科杂志,2023,22(01):37.[doi:10.3760/cma.j.cn101785-202108052-008]
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,2023,22(12):37.[doi:10.3760/cma.j.cn101785-202108052-008]
备注/Memo
收稿日期:2019-09-10。
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