Liu Zhenyin,Wen Zhe,Liu Tao,et al.Clinical application of balloon dilatation for anastomotic stenosis after meso-Rex bypass for cavernous transformation of the portal vein[J].Journal of Clinical Pediatric Surgery,2019,18(12):999-1003.[doi:10.3969/j.issn.1671-6353.2019.12.003]
门静脉海绵样变Rex手术后桥血管吻合口狭窄球囊扩张术初步探讨
- Title:
- Clinical application of balloon dilatation for anastomotic stenosis after meso-Rex bypass for cavernous transformation of the portal vein
- Keywords:
- Portal Cavernoma; Blood Vessels; Stomas; Balloon Dilatation
- 分类号:
- R654.3;R657.3+4
- 摘要:
- 目的 探讨球囊扩张术在儿童门静脉海绵样变（cavernous transformation of the portal vein，CTPV）Rex手术后桥血管与肝内门静脉左支吻合口狭窄中的应用效果。方法 收集2018年11月至2019年4月由广州市妇女儿童医疗中心收治的CTPV Rex手术后桥血管吻合口狭窄并行介入治疗的5例患儿作为研究对象，其中男童2例，女童3例，年龄1.9~11岁。术前超声或CT检查显示桥血管吻合口不同程度狭窄，狭窄口内径为1~3.5 mm。结果 5例CTPV患儿共行8次经皮肝穿刺门静脉入路血管扩张介入术，其中3例患儿仅行1次介入术（2例成功，另1例未成功）；1例行2次介入（第1次未成功，第2次成功实施血管狭窄吻合口球囊扩张术）；1例患儿因吻合口极度狭窄，约1 mm，前2次均未成功将导丝通过血管吻合口狭窄部，第3次联合肝胆外科，成功实施球囊扩张术。球囊扩张术后随访6~9个月，超声复查显示血管吻合口内径较术前扩大。5例CTPV患儿8次介入术中均未出现并发症。结论 经皮肝穿刺肝内门静脉入路，对门静脉海绵样变Rex手术后桥血管吻合口狭窄的患儿实施球囊扩张术创伤小，疗效显著，有助于完善儿童CTPV治疗措施。
- Abstract:
- Objective To explore clinical application of balloon dilatation for anastomotic stenosis after meso-Rex bypass (Rex) operation for cavernous transformation of the portal vein (CTPV).Methods Five CTPV patients developed anstomotic stenosis after Rex operation from November 2018 to April 2019.There were 2 boys and 3 girls with an age range of 1.9 to 11 years.Preoperative ultrasonography or computed tomograph (CT) showed stenosis in Rex shunt and the inner diameter of stenosis was 1 to 3.5 mm.Results Five patients underwent a total of 8 percutaneous transhepatic portal vein vasodilator interventions.Three of them underwent intervention once (2 successful,1 unsuccessful) and 1 twice (the first unsuccessful,the second successful).One patient had an extremet anastomotic stenosis of around 1 mm,the first and second operations failed to pass the guide wire through vascular stenosis and the third dilatation was successful with open laparotomy.The follow-up period was 6 to 9 months after dilatation.Ultrasonography showed that the diameter of anastomotic ostium expanded postoperatively.No complications occurred during 8 interventions.Conclusion Balloon dilatation is effective for anastomotic stenosis after Rex operation.And it contributes to improved treatment of CTPV in children.
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备注/Memo
收稿日期:2019-10-14。
基金项目:广东省省级科技计划项目（编号：2014A020212026）
通讯作者:张靖,Email:fejr@foxmail.com