保留脾脏的脾静脉近端－门静脉左支分流术治疗小儿肝外门静脉高压  

Efficacy and prognosis of spleen-preserving proximal splenic-left intrahepatic portal shunt in the treatment of extra-hepatic portal hypertension in children

作　　者：张金山[1] 李龙[1] 侯文英[1] 刘树立[1] 刁美[1] 张军[1] 李颀[1] 吴涛[1] 叶茂[1] 董宁[1] 

机构地区：[1]首都儿科研究所普外科,北京100020

出　　处：《中华小儿外科杂志》2015年第4期278-281,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨保留脾脏的脾静脉近端一门静脉左支分流术治疗小儿肝外门静脉高压的效果和预后。方法2011年6月至2013年8月，4例患儿因“呕血、黑便”等上消化道出血症状就诊于我院，其中男1例，女3例，年龄1．7～5．8岁（平均3．9岁）。完善腹部B型超声，增强CT和血常规检查，B超和CT均提示门静脉海绵样变、脾大和脾功能亢进，以“肝外门静脉高压”收入院。所有患儿均采用保留脾脏的脾静脉近端一门静脉左支分流术治疗肝外门静脉高压。所有患儿术后随访，随访时间为7～33个月（平均20．8个月）。随访期间，采用超声评估脾脏大小和分流血管通畅情况。记录血常规和血生化检查结果。结果所有患儿成功采用保留脾脏的脾静脉近端一门静脉左支分流术治疗。手术时间215～260min，平均237．5min。1例患儿术中输入1个单位同型红细胞，其余患儿未输血。术后住院时间4～6d，平均5．3d。术后门静脉造影显示所有患儿分流血管通畅。术后患儿血常规及血生化结果正常，随访超声显示分流血管通畅，脾脏明显缩小。无患儿复发。结论保留脾脏的脾静脉近端一门静脉左支分流术是治疗小儿肝外门静脉高压的有效方法。Objective To explore the efficacy and prognosis of Spleen-preserving proximal splenic-left intrahepatic portal shunt in the treatment of extra-hepatic portal hypertension in children. Methods Four children of portal hypertension were recruited. There were 1 boy and 3 girls with a mean operative age of 3. 9 （1.7-5.8） years. Spleen-preserving proximal splenic-left intrahepatic portal shunt was performed. Splenic vein was completely separated from pancreatic bed to its junction with inferior mesenteric vein. And proximal splenic vein was ligated at the branch of splenic vessels. Proximal splenic vein was anastomosed to left portal vein. The mean follow-up period was 20. 8 （7-33） months. Results The mean operative duration was 237.5 （215-260） rain. One patient received transfusion. And the mean postoperative length of hospital stay was 5.3 （4-6） days. Intraoperative portal venous angiography demonstrated the patency of shunt in all patients. Postoperatively, complete blood count normalized and biochemical tests were within normal range. Postoperative ultrasound confirmed shunt patency and satisfactory flow in proximal splenic-portal shunt in each patient. The size of spleen markedly decreased. There was no postoperative recurrence of variceal hemorrhage. Conclusions Spleen-preserving proximal splenic-portal shunt is an effective treatment of extra-hepatic portal hypertension.

关 键 词：门静脉高压 脾静脉 门静脉 

分 类 号：R726.5[医药卫生—儿科]