[1]戚士芹,卞剑,未德成,等.Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变疗效分析[J].临床小儿外科杂志,2019,18(12):1014-1017,1035.[doi:10.3969/j.issn.1671-6353.2019.12.006]
　Qi Shiqin,Bian Jian,Wei Decheng,et al.Rex shunting plus devascularization and ligation of splenic artery for cavernous transformation of the portal vein in children[J].Journal of Clinical Pediatric Surgery,2019,18(12):1014-1017,1035.[doi:10.3969/j.issn.1671-6353.2019.12.006]
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Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变疗效分析

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第18卷 期数: 2019年12期 页码: 1014-1017,1035 栏目: 专题·门静脉高压 出版日期: 2019-12-30
Title:
Rex shunting plus devascularization and ligation of splenic artery for cavernous transformation of the portal vein in children
作者:
戚士芹;  卞剑;  未德成;  杨涌
安徽医科大学附属省儿童医院普外科(安徽省合肥市, 230053)
Author(s):
Qi Shiqin;  Bian Jian;  Wei Decheng;  Yang Yong
Department of Pediatric Surgery, Anhui Provincial Children’s Hospital, Hefei 230053, China
关键词:
门静脉海绵样变; Rex分流术; 脾动脉; 结扎术; 治疗结果; 儿童
Keywords:
Portal Cavernoma; Rex Shunt; Splenic Artery; Ligation; Treatment Outcome; Child
分类号:
R726;R575;R657.3+4
DOI:
10.3969/j.issn.1671-6353.2019.12.006
摘要:
目的 总结Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变的经验与疗效。方法 回顾性分析2012年8月至2019年7月在安徽省儿童医院行Rex分流联合断流、脾动脉结扎术治疗的16例门静脉海绵样变、门静脉高压症患儿临床资料及随访结果。结果 15例成功手术，分流前门静脉测压28.3~45.8 cm H2O，平均（32.6±5.4）cm H2O，分流后显著下降为17.2~27.8 cm H2O，平均（23.4±3.7）cm H2O，分流前后门静脉压力差异有统计学意义（P<0.01）。术后均恢复出院。1例术中吻合血管不通畅加行Warren术，术后脾肾静脉吻合口血栓形成，介入治疗效果不显著，自动出院后死亡。成功手术的15例患儿术后随访6个月至6年，平均随访31.5个月，3例术后有消化道出血复发，药物止血均较易控制，其中2例均复发1次，1例复发2次后未再出血，但出现脾大、脾功能亢进，术后5年行脾切除术。15例均生长发育良好。结论 Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变所致门静脉高压症效果确切。
Abstract:
Objective To summarize our experiences of treating cavernous transformation of the portal vein (CTPV) in children.Methods A total of 16 children underwent Rex shunting plus devascularization and ligation of splenic artery for CTPV from August 2012 to July 2019.Their clinical data and follow-up results were recorded and analyzed.Results Among them,15 cases were successfully operated.Prior to shunting,the average pressure of portal vein was (32.6±5.4)(28.3-45.8) cm H2O.After shunting,the average pressure of portal vein declined to (23.4±3.7)(17.2-27.8) cm H2O.And the difference was statistically significant (P<0.01).After operation,all of them recovered well and were discharged.One child underwent further Warren shunting and died after giving up for further interventions.During an average follow-up period of 31.5(6-72) months,3 cases with a recurrence of upper gastrointestinal hemorrhage were controlled easily with drugs.One child underwent splenectomy for hypersplenism at 5 years.All of them had excellent growth and development.Conclusion Rex shunt plus devascularization and ligation of splenic artery is efficacious for treating pediatric CTPV.

参考文献/References:

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备注/Memo

收稿日期:2019-10-08。
基金项目:安徽医科大学校科研基金项目（编号：2019xkj179）
通讯作者:戚士芹,Email:qishiqin@163.com

更新日期/Last Update: 1900-01-01