肠门分流（Rex手术）治疗肝外型门静脉高压的初步研究  

Rex shunt for portal hypertension in children with cavernous transformation of portal vein.

作　　者：刘树立[1] 李龙[1] 侯文英[1] 张军[1] 谢华伟[1] 王文晓[1] 周峻[1] 崔龙[1] 张金山[1] 张秀敏[2] 

机构地区：[1]首都儿科研究所,北京市100020 [2]唐山市丰润区第二人民医院妇幼保健院,河北省063030

出　　处：《临床小儿外科杂志》2009年第6期13-16,共4页Journal of Clinical Pediatric Surgery

基　　金：国家十一五科技支撑课题（项目编号2006BA105A00）及首发基金课题（项目编号2005-1034）.

摘　　要：目的探讨肠系膜上静脉门静脉左支分流术（Rex手术）治疗门静脉海绵样变的临床效果：方法2008年10月至2009年9月本院共收治6例门静脉海绵样变性并门脉高压患儿。年龄20～82个月，均为男性。4例有反复上消化道出血、呕血、输血史，输血量800～2400mL；2例表现为巨睥、脾功能亢进、进行性贫血。5例患儿术前红细胞、白细胞、血小板不同程度降低；肝功能各项指标均正常。术前影像学检查提示：食管胃底静脉曲张，门脉海绵样变；脾脏增大。手术采用上腹肋缘下横切口，测定肠系膜上静脉压力，并行门静脉造影。游离胃冠状静脉达食管裂孔水平，离断。游离肝门静脉左主支，阻断并纵行劈开矢状部，然后以6-0Prolene线将胃冠状静脉与门静脉左支行端侧吻合。再次测定肠系膜上静脉压力，并行血管造影。术后随访3～11个月。结果6例均成功实施手术，手术时间200．240min，出血约20～30mL，分流完成后造影显示分流血管均通畅无狭窄。分流前门静脉压力39～53cmH2O，分流后降为29～32cmH2O。术后住院时是7～12d：随访期间患儿未再出现呕血，影像学检查显示分流血管通畅，肝功能各项指标正常；血小板、红细胞、血红蛋白、白细胞正常；脾脏较术前缩小，厚度3．5～4．0cm。结论Rex分流术治疗门静脉海绵样变性安全、可行，效果良好。Objective To explore the effectiveness and safety of Rex shunt for patients with cavernous transformation of portal vein （ CTPV ）. Methods Six male children aged from 60 to 82 months with CTPV were recruited between October 2008 and April 2009. Four of them suffered with recurrence upper GI bleeding, and two with splenomegaly and hypersplenism. Upper GI radiography （UGIR） shown esophageal-gastric varices （EGV） and Ultrasonograph （US） shown CTPV in all patients. All patients underwent Rex shunt and were followed up 3, 5, 4, 7, 10, 11 months respectively. Results Median duration of operation was 3.5 hours （range, from 3.3 to 4 hours） without intraoperative problems, and intraoperative bleeding was 30 to 50 ml without necessity for blood transfusion. Portal pressure decreased after Rex shunt. The postoperative course was uneventful in 6 patients with hospital stay from 7 to 12 days after the operation. Gastrointestinal bleeding did not recur in any patient, and spleen size decreased. Platelet count and white blood cell count increased, and there was no postoperative complication during followed-up visits. Conclusions Rex shunt for patients with CTPV is feasible, safe and effective.

关 键 词：门体分流术 外科/方法 高血压 门静脉/外科学 

分 类 号：R735.9[医药卫生—肿瘤] R713.42[医药卫生—临床医学]