Zhang Jinshan.Technical challenges and implementation considerations for Rex shunt[J].Journal of Clinical Pediatric Surgery,2025,(01):86-90.[doi:10.3760/cma.j.cn101785-202208033-016]
浅析Rex手术的技术难点及实施条件
- Title:
- Technical challenges and implementation considerations for Rex shunt
- 摘要:
- Rex手术自1992年被de Ville首次应用于治疗肝外门静脉梗阻 (extra-hepatic portal venous obstruction,EHPVO) 以来,已经开展了三十余年。尽管其已经是一种非常成熟的手术技术,但能开展该技术的中心数量依然有限。关于哪些原因可能导致开展Rex手术的医院较少以及成功实施Rex手术需要哪些条件等问题,既往暂无文献对此进行系统分析。为此,本文通过总结作者自身开展Rex手术的临床经验和国内外的应用情况,详细分析Rex手术的技术难点和应用进展,为已经开展Rex手术、初步应用该技术和准备开展该技术的医师、科室或医院提供一定的借鉴。
- Abstract:
- As a well-established surgical approach for extrahepatic portal venous obstruction (EHPVO),Rex shunt has been employed for over three decades since its introduction by de Ville in 1992.Despite its maturity,the number of centers performing Rex surgery remains limited.This review focused upon this gap through systematically analyzing the technical complexities and implementation requirements for successful Rex shunt.Drawing upon personal clinical experience and a review of both domestic and international literature,it discussed technical challenges associated with Rex shunt and its current application landscape.It served as valuable references for surgeons,departments and hospitals already performing,considering or preparing to implement Rex shunt.
参考文献/References:
[1] 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):636-640.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):636-640.DOI:10.3760/cma.j.issn.0253-3006.2017.08.018.
[2] Zhang JS, Li L.Rex shunt for extra-hepatic portal venous obstruction in children[J]. Children (Basel), 2022, 9(2):297.DOI:10.3390/children9020297.
[3] 张金山, 李龙.小儿肝硬化门脉高压症的研究新进展[J]. 中华小儿外科杂志, 2010, 31(9):702-705.DOI:10.3760/cma.j.issn.0253-3006.2010.09.014. Zhang JS.Li L.New advances in the study of portal hypertension in children with liver cirrhosis[J]. Chin J Pediatr Surg, 2010, 31(9):702-705.DOI:10.3760/cma.j.issn.0253-3006.2010.09.014.
[4] Superina R, Shneider B, Emre S, et al.Surgical guidelines for the management of extra-hepatic portal vein obstruction[J]. Pediatr Transplant, 2006, 10(8):908-913.DOI:10.1111/j.1399-3046.2006.00598.x.
[5] de Ville de Goyet J, Alberti D, Clapuyt P, et al.Direct bypassing of extrahepatic portal venous obstruction in children:a new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension[J]. J Pediatr Surg, 1998, 33(4):597-601.DOI:10.1016/s0022-3468(98)90324-4.
[6] Brichard M, Iesari S, Lerut J, et al.Meso-Rex bypass for the management of extrahepatic portal vein obstruction in adults (with video)[J]. Hepatobiliary Pancreat Dis Int, 2022, 21(1):25-32.DOI:10.1016/j.hbpd.2021.08.003.
[7] 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.
[8] 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.
[9] Alberti D, Colusso M, Cheli M, et al.Results of a stepwise approach to extrahepatic portal vein obstruction in children[J]. J Pediatr Gastroenterol Nutr, 2013, 57(5):619-626.DOI:10.1097/MPG.0b013e31829fad46.
[10] Luoto T, Pakarinen M, Mattila I, et al.Mesoportal bypass using a constructed saphenous vein graft for extrahepatic portal vein obstruction-technique, feasibility, and outcomes[J]. J Pediatr Surg, 2012, 47(4):688-693.DOI:10.1016/j.jpedsurg.2011.10.065.
[11] Lautz TB, Keys LA, Melvin JC, et al.Advantages 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.
[12] Cortez AR, Kassam AF, Jenkins TM, et al.The role of surgical shunts in the treatment of pediatric portal hypertension[J]. Surgery, 2019, 166(5):907-913.DOI:10.1016/j.surg.2019.05.009.
[13] Guérin F, Bidault V, Gonzales E, et al.Meso-Rex bypass for extrahepatic portal vein obstruction in children[J]. Br J Surg, 2013, 100(12):1606-1613.DOI:10.1002/bjs.9287.
[14] Krebs-Schmitt D, Briem-Richter A, Grabhorn E, et al.Effectiveness of Rex shunt in children with portal hypertension following liver transplantation or with primary portal hypertension[J]. Pediatr Transplant, 2009, 13(5):540-544.DOI:10.1111/j.1399-3046.2008.01109.x.
[15] Ha TY, Kim KM, Ko GY, et al.Variant meso-Rex bypass with transposition of abdominal autogenous vein for the management of idiopathic extrahepatic portal vein obstruction:a retrospective observational study[J]. BMC Surg, 2015, 15:116.DOI:10.1186/s12893-015-0101-6.
[16] Ate? O, Hakgüder 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] Zhang JS, Li L, Cheng W.The optimal procedure of modified Rex shunt for the treatment of extrahepatic portal hypertension in children[J]. J Vasc Surg Venous Lymphat Disord, 2017, 5(6):805-809.DOI:10.1016/j.jvsv.2017.02.011.
[18] Ruan ZM, Wu M, Shao CC, et al.Effects of Rex-bypass shunt on the cavernous transformation of the portal vein in children:evaluation by the color Doppler ultrasonography[J]. Insights Imaging, 2020, 11(1):4.DOI:10.1186/s13244-019-0815-6.
[19] Wu HY, Zhou N, Lu LW, et al.Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction[J]. Insights Imaging, 2021, 12(1):109.DOI:10.1186/s13244-021-01057-8.
[20] Zhang JS, Li L.Imaging features and clinical relevance of portal venous systems shown by extrahepatic portal angiography in children with extrahepatic portal venous obstruction[J]. J Vasc Surg Venous Lymphat Disord, 2020, 8(5):756-761.DOI:10.1016/j.jvsv.2019.11.016.
[21] 张金山, 李龙.改良Rex手术治疗小儿肝外门静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):585-590.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):585-590.DOI:10.3760/cma.j.issn.0253-3006.2017.08.007.
[22] Li L, Zhang JS, Chen Z, 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.
[23] 张金山, 李龙.肝素联合波立维抗凝方案在Rex手术治疗小儿肝外门静脉梗阻中的应用及疗效分析[J]. 临床小儿外科杂志, 2022, 21(2):146-150.DOI:10.3760/cma.j.cn101785-202102027-009. Zhang JS, Li L.Anticoagulant therapy of heparin plus plavix after Rex shunt for children with extrahepatic portal venous obstruction[J]. DOI:10.3760/cma.j.cn101785-202102027-009.
[24] Superina R, Bambini DA, Lokar J, et al.Correction of extrahepatic portal vein thrombosis by the mesenteric to left portal vein bypass[J]. Ann Surg, 2006, 243(4):515-521.DOI:10.1097/01.sla.0000205827.73706.97.
[25] Zhang JS, Li L, Cheng W.Surgical treatment for rebleeding caused by bypass failure after Rex shunt:re-Rex shunt or Warren shunt?[J]. Pediatr Surg Int, 2018, 34(5):521-527.DOI:10.1007/s00383-018-4246-0.
相似文献/References:
[1]张金山,李龙.Rex手术治疗胆总管囊肿术后门静脉海绵样变的应用研究[J].临床小儿外科杂志,2019,18(12):1004.[doi:10.3969/j.issn.1671-6353.2019.12.004]
Zhang Jinshan,Li Long.Efficacy of Rex shunt for portal cavernoma after hepaticojejunostomy in children with choledochal cyst[J].Journal of Clinical Pediatric Surgery,2019,18(01):1004.[doi:10.3969/j.issn.1671-6353.2019.12.004]
[2]张金山,李龙.肝素联合波立维抗凝方案在Rex手术治疗小儿肝外门静脉梗阻中的应用及疗效分析[J].临床小儿外科杂志,2022,21(02):146.[doi:10.3760/cma.j.cn.101785-202102027-009]
Zhang Jinshan,Li Long.Anticoagulant therapy of heparin plus plavix after Rex shunt for children with extrahepatic portal venous obstruction[J].Journal of Clinical Pediatric Surgery,2022,21(01):146.[doi:10.3760/cma.j.cn.101785-202102027-009]
备注/Memo
收稿日期:2022-8-19。
基金项目:国家自然科学基金(82170679);首都卫生发展科研专项(首发2024-2-2101);北京市医师科学家培养项目(BJPSTP-2024-28)
通讯作者:张金山,Email:zjs851@163.com