Yang Yang,Lyu Zhenyu,Wang Zhiyuan,et al.Clinical application of transjugular wedge hepatic venography with retrograde portal venography in preoperative evaluations for cavernous transformation of the portal vein[J].Journal of Clinical Pediatric Surgery,2026,(09):867-871.[doi:10.3760/cma.j.cn101785-202505020]
经颈静脉楔入法肝静脉逆行门静脉造影在门静脉海绵样变术前评估中的临床应用
- Title:
- Clinical application of transjugular wedge hepatic venography with retrograde portal venography in preoperative evaluations for cavernous transformation of the portal vein
- Keywords:
- Jugular Vein; Portal Venography; Child
- 摘要:
- 目的 探讨经颈静脉楔入法肝静脉逆行门静脉造影在门静脉海绵样变患者中进行术前评估的临床价值及介入操作方法。方法 本研究为回顾性病例系列研究。纳入2021年1月至2024年12月首都医科大学附属北京儿童医院收治的门静脉海绵样变患儿25例，其中男12例、女13例，入院年龄（91.74±40.44）个月，均行经颈静脉楔入法肝静脉逆行门静脉造影及增强CT检查。探讨经颈静脉楔入法肝静脉逆行门静脉造影的入路选择、操作经验、结果判读，与增强CT影像结果进行比较，并经外科术中探查验证，明确经颈静脉楔入法肝静脉逆行门静脉造影在判断儿童肝内门静脉发育及Rex血管条件的准确性。结果 根据造影形态，按照Bertocchini分类方法，25例患儿中，A型11例、B型7例、C型1例、D型3例、E型3例。楔入法逆行造影较增强CT显示Rex血管、肝内门静脉通畅情况和解剖走行更清晰、准确。A、B、C型在外科术中均成功解剖出Rex血管，并搭桥成功。结论 在门静脉海绵样变患儿中，经颈静脉楔入法肝静脉逆行门静脉造影，颈静脉入路操作更简单，能清晰显示Rex血管条件、肝内左右门静脉系统通畅情况，在腹部增强CT评估后应完善该造影检查，有助于外科医师手术方式的选择，是一种安全有效准确的术前评估方法。
- Abstract:
- Objective To explore the clinical value and interventional procedural techniques of transjugular wedge hepatic vein retrograde portography for preoperative evaluation in children with portal cavernous transformation.Methods Twenty-five children with portal cavernous transformation admitted from January 2021 to December 2024 were recruited.The cohort comprised 12 boys and 13 girls with a mean age of (91.74±40.44) month at admission.Transjugular wedge hepatic vein retrograde portography and contrast-enhanced computed tomography (CT) were performed.The study focused upon route selection,operational experience and interpretation of results for retrograde portography.The findings were compared with contrast-enhanced CT and validated by intraoperative surgical exploration for evaluating the accuracy of this method in assessing intrahepatic portal vein development and Rex vessel status in children.Results Based upon the Bertocchini classification,angiography revealed type A (n=11),type B (n=7),type C (n=1),type D (n=3) and type E (n=3).Retrograde wedge angiography offered more distinct and accurate visualization of Rex vessels,intrahepatic portal vein patency and anatomical pathways as compared with contrast-enhanced CT.Types A,B and C successfully underwent Rex vessel dissection and bypass grafting during surgery.Conclusions In children with portal cavernous transformation,transjugular wedge hepatic vein retrograde portography via a jugular approach proves a simpler procedure.It clearly delineates Rex vessel status and intrahepatic left/right portal vein patency during enhanced CT evaluation of abdomen.It assists surgeons in selecting appropriate surgical approaches.The above method is a safe,effective,and accurate preoperative assessment tool.
参考文献/References:
[1] 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.
[2] de Ville de Goyet J,Clapuyt P,Otte JB.Extrahilar mesenterico-left portal shunt to relieve extrahepatic portal hypertension after partial liver transplant[J].Transplantation,1992,53(1):231-232.
[3] Kathemann S,Lainka E,Ludwig JM,et al.Imaging of the intrahepatic portal vein in children with extrahepatic portal vein thrombosis-Comparison of magnetic resonance imaging and retrograde portography[J].J Pediatr Surg,2019,54(8):1686-1690.DOI:10.1016/j.jpedsurg.2018.10.049.
[4] Lawson AJ,Rischbieter P,Numanoglu A,et al.Imaging the Rex vein preoperatively using wedged hepatic venous portography[J].Pediatr Radiol,2011,41(10):1246-1249.DOI:10.1007/s00247-011-2188-y.
[5] Carollo V,Marrone G,Cortis K,et al.Multimodality imaging of the Meso-Rex bypass[J].Abdom Radiol (NY),2019,44(4):1379-1394.DOI:10.1007/s00261-018-1836-1.
[6] Marra P,Dulcetta L,Carbone FS,et al.The role of imaging in portal vein thrombosis:from the diagnosis to the interventional radiological management[J].Diagnostics (Basel),2022,12(11):2628.DOI:10.3390/diagnostics12112628.
[7] 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.
[8] Bertocchini A,Falappa P,Grimaldi C,et al.Intrahepatic portal venous systems in children with noncirrhotic prehepatic portal hypertension:anatomy and clinical relevance[J].J Pediatr Surg,2014,49(8):1268-1275.DOI:10.1016/j.jpedsurg.2013.10.029.
[9] Elkrief L,Houssel-Debry P,Ackermann O,et al.Portal cavernoma or chronic non cirrhotic extrahepatic portal vein obstruction[J].Clin Res Hepatol Gastroenterol,2020,44(4):491-496.DOI:10.1016/j.clinre.2020.03.016.
[10] de Franchis R,Bosch J,Garcia-Tsao G,et al.Baveno VII-renewing consensus in portal hypertension[J].J Hepatol,2022,76(4):959-974.DOI:10.1016/j.jhep.2021.12.022.
[11] Khanna R,Sarin SK.Noncirrhotic portal hypertension:current and emerging perspectives[J].Clin Liver Dis,2019,23(4):781-807.DOI:10.1016/j.cld.2019.07.006.
[12] Hwang M,Thimm MA,Guerrerio AL.Detection of cavernous transformation of the portal vein by contrast-enhanced ultrasound[J].J Ultrasound,2018,21(2):153-157.DOI:10.1007/s40477-018-0288-3.
[13] 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.
备注/Memo
收稿日期:2025-5-13。
通讯作者:肖燕燕,Email:xiaoyanyan00@sina.com