Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变疗效分析  

Rex shunting plus devascularization and ligation of splenic artery for cavernous transformation of the portal vein in children

作　　者：戚士芹[1] 卞剑[1] 未德成[1] 杨涌[1] Qi Shiqin;Bian Jian;Wei Decheng;Yang Yong(Department of Pediatric Surgery,Anhui Provincial Children's Hospital,Hefei 230053,China)

机构地区：[1]安徽医科大学附属省儿童医院普外科

出　　处：《临床小儿外科杂志》2019年第12期1014-1017,1035,共5页Journal of Clinical Pediatric Surgery

基　　金：安徽医科大学校科研基金项目(编号:2019xkj179)

摘　　要：目的总结Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变的经验与疗效。方法回顾性分析2012年8月至2019年7月在安徽省儿童医院行Rex分流联合断流、脾动脉结扎术治疗的16例门静脉海绵样变、门静脉高压症患儿临床资料及随访结果。结果15例成功手术,分流前门静脉测压28.3~45.8 cm H 2O,平均(32.6±5.4)cm H 2O,分流后显著下降为17.2~27.8 cm H 2O,平均(23.4±3.7)cmH 2O,分流前后门静脉压力差异有统计学意义(P<0.01)。术后均恢复出院。1例术中吻合血管不通畅加行Warren术,术后脾肾静脉吻合口血栓形成,介入治疗效果不显著,自动出院后死亡。成功手术的15例患儿术后随访6个月至6年,平均随访31.5个月,3例术后有消化道出血复发,药物止血均较易控制,其中2例均复发1次,1例复发2次后未再出血,但出现脾大、脾功能亢进,术后5年行脾切除术。15例均生长发育良好。结论Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变所致门静脉高压症效果确切。Objective To summarize our experiences of treating cavernous transformation of the portal vein(CTPV)in children.Methods A total of 16 children underwent Rex shunting plus devascularization and ligation of splenic artery for CTPV from August 2012 to July 2019.Their clinical data and follow-up results were recorded and analyzed.Results Among them,15 cases were successfully operated.Prior to shunting,the average pressure of portal vein was(32.6±5.4)(28.3-45.8)cm H 2O.After shunting,the average pressure of portal vein declined to(23.4±3.7)(17.2-27.8)cm H 2O.And the difference was statistically significant(P<0.01).After operation,all of them recovered well and were discharged.One child underwent further Warren shunting and died after giving up for further interventions.During an average follow-up period of 31.5(6-72)months,3 cases with a recurrence of upper gastrointestinal hemorrhage were controlled easily with drugs.One child underwent splenectomy for hypersplenism at 5 years.All of them had excellent growth and development.Conclusion Rex shunt plus devascularization and ligation of splenic artery is efficacious for treating pediatric CTPV.

关 键 词：门静脉海绵样变 Rex分流术 脾动脉 结扎术 治疗结果 儿童 

分 类 号：R726[医药卫生—儿科] R575[医药卫生—临床医学]