Wang Yi,Yao Zhiguang,Liu Yingsong,et al.Clinical efficacies of Rex shunt (internal jugular vein) for pediatric prehepatic portal hypertension[J].Journal of Clinical Pediatric Surgery,2019,18(12):1018-1022.[doi:10.3969/j.issn.1671-6353.2019.12.007]
应用颈内静脉搭桥Rex手术治疗门静脉海绵样变的临床研究
- Title:
- Clinical efficacies of Rex shunt (internal jugular vein) for pediatric prehepatic portal hypertension
- Keywords:
- Portasystemic Shunt; Transjugular Intrahepatic; Portal Cavernoma; Surgical Procedures; Operative; Treatment Outcome
- 分类号:
- R726;R657.3+4
- 摘要:
- 目的 探讨应用颈内静脉做移植血管的Rex手术治疗门静脉海绵样变的临床疗效。方法 2015年5月至2018年5月东莞市儿童医院共收治12例门静脉海绵样变性患儿，年龄89~180个月，男童7例，女童5例。10例存在反复上消化道出血病史。12例均表现为脾功能亢进，术前红细胞、白细胞、血小板都呈现不同程度降低；肝功能各项指标均正常。术前影像学检查均提示：食管胃底静脉曲张，门静脉海绵样变；脾脏肿大。术后随访12~24个月。结果 12例均成功实施手术，手术时间为380~480 min，出血量为30~150 mL，分流术前测肠系膜上静脉压力为24~37 cm H2O，平均为（32.5±3.7）cm H2O，分流术后降为17~34 cm H2O，平均为（23.5±4.7）cm H2O，分流术前后肠系膜上静脉压力差异有统计学意义（t=5.19，P=0.001）。术后复查血细胞计数较术前均有不同程度升高，手术前后白细胞分别为（2.1±0.6）×1012 g/L和（4.4±2.3）×1012/L，差异有统计学意义（t=3.29，P=0.003）；手术前后血红蛋白分别为（65.2±19.5）g/L和（101.2±13.9）g/L，差异有统计学意义（t=5.70，P=0.001）；手术前后血小板分别为（70.5±33.1）×109/L和（161.17±66.8）×109/L，差异有统计学意义（t=4.21，P=0.001）。术后12个月复查脾脏长度、厚度较术前均有缩小，差异有统计学意义（P=0.001）。随访期间患儿未再发生呕血，影像学检查显示分流血管通畅，肝功能各项指标正常。结论 应用颈内静脉做移植血管的Rex分流术治疗门静脉海绵样变性效果良好。
- Abstract:
- Objective To explore the efficacies of Rex shunt for children with cavernous transformation of portal vein (CTPV).Methods 7 boys and 5 girls with CTPV aged from 89 to 180 months were recruited between May 2015 and May 2018. There were recurrent upper gastrointestinal (GI) hemorrhage (n=10) and hypersplenism (n=12). Upper GI radiography (UGIR) indicated esophageal-gastric varices (EGV) and ultrasonograph (Us) hinted at CTPV in all children. After Rex shunt,the follow-up period was 12 to 24 months. Results The median operative duration was 420(380-480) min and the volume of intraoperative hemorrhage 30 to 150 mL without a necessity for blood transfusion. The mean pressure of inferior mesenteric vein was (32.5±3.7)(24-37) cm H2O before shunting and (23.5±4.7)(17-34) cm H2O after shunting. And the difference was statistically significant (t=5.19,P=0.001). The preoperative and postoperative counts of leucocytes were (2.1±0.6)×1012g/L and (4.4±2.3)×1012g/L. And the difference was statistically significant (t=3.29,P=0.003). Hemoglobin was (65.2±19.5) g/L and (101.2±13.9) g/L before and after operation respectively and the difference was statistically significant (t=5.70,P=0.001). The count of platelet was (70.5±33.1)×109/L and (70.5±33.1)×109/L before and after operation respectively and the difference was statistically significant (t=4.21,P=0.001). The length and thickness of spleen were smaller at 12 months post-operation than those pre-operation. The difference was statistically significant (P=0.001). No postoperative complications occurred during follow-ups. Conclusion Rex shunt is feasible, safe and effective for pediatric CTPV.
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备注/Memo
收稿日期:2019-09-24。
基金项目:东莞市社会科技发展重点项目（编号：201950715028167）
通讯作者:马达,Email:804103064@qq.com