脾腔分流术治疗小儿肝外型门脉高压症  

Splenocaval shunts for extrahepatic portal hypertension in children

作　　者：肖现民[1] 周以明[1] 

机构地区：[1]上海医科大学儿科医院外科

出　　处：《肝胆外科杂志》1996年第4期206-207,共2页Journal of Hepatobiliary Surgery

摘　　要：脾肾静脉分流是治疗小儿肝外型门脉高压症的有效手段，但因肾静脉位置深、细小，增加了手术难度，影响疗效。报告我院近期采用脾腔静脉分流术式治疗３例，均为女性，年龄９～１２岁，反复出血史６～１０年。钡餐示重度食道静脉曲张，肝外病变由彩色超声检查证实。术中切除脾脏，测得脾静脉口径６～９ｍｍ。将脾静脉与下腔静脉作端侧吻合，手术顺利。术后随访１２～１８个月，２例一般情况良好，１例（脾静脉口径６ｍｍ）术后８个月时曾小量出血１次。近期复查食道静脉曲张明显改善２例，消失１例，吻合口均通畅。与脾肾分流比较，脾腔分流避免了肾静脉对吻合的限制，利用下腔静脉位置恒定、口径大、血流量大的优点，暴露良好，吻合操作便利，对儿童尤为适合。１例术后虽然吻合口通畅，仍发生出血的现象提示脾腔分流以脾静脉口径接近１０ｍｍ为宜。Although extrahepatic portal hypertension(EHPH) can be effectively managed by splenorenal shunts(SRS),the relatively small caliber of renal vein in child may become a trouble during these operations. Recently splenocaval shunt(SCS)procedure was performed for EHPH in 3 patients. They were all girls,aged 9-12 years,with histories of recurrent episodes of variceal bleeding for more than 6 years. After splenectomy,splenic vein(69 mm in diameter)was anastomosed to the infrarenal vena caca. The girls recovered from SCS uneventfully. Postoperative follow-up for 16-18 months showed that 2 girls had patent shunts and cessation of bleeding. Eight months postoperatively the third girl had a mild episode of bleeding,whose splenic vein was 6 mm in diameter. But her esophageal varices were much better improved and shunt remained patent. The results suggest that SCS is an alterantive to SRS in the treatment of podiatric EHPH. The advantages of SCS over SRS are also discussed.

关 键 词：门脉高血压 肝外型 门体分流术 儿童 

分 类 号：R726.573.4[医药卫生—儿科]