外科结扎门体分流治疗12例Ⅱ型Abernethy畸形的疗效分析  

Surgical ligation of porto-systemic shunt for the treatment of type Ⅱ Abernethy malformation in 12 children

作　　者：张金山[1] 陈兴海[1] 李龙[1] 侯文英[1] Zhang Jinshan;Chen Xinghai;Li Long;Hou Wenying(Department of General Surgery,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所普外科,北京100020

出　　处：《中华普通外科杂志》2020年第10期792-796,共5页Chinese Journal of General Surgery

基　　金：国家自然科学基金(81770595)。

摘　　要：目的探讨门体分流结扎术治疗小儿先天性肝外门体分流(Abernethy畸形)的可行性及效果。方法回顾性分析2014年5月至2019年11月首都儿科研究所普外科12例Abernethy畸形患儿的外科手术过程和结果,主要临床表现:便血9例,血清转氨酶升高和黄疸2例,低氧血症1例。当阻断引流后门静脉压力≤26cm H2O(1cm H2O=0.098 kPa)时,完全结扎门体分流;当阻断引流后门静脉压力>26cm H20时,行门体分流部分结扎术,保持门静脉压力在26cm H20左右,二期手术再行完全结扎分流血管。术后随访5~70个月(平均35.2个月)。结果本组12例Abernethy畸形患儿中6例行引流一期完全结扎,5例行分期结扎,1例行部分结扎术治疗,其中3例患儿因门静脉主干发育纤细,在行结扎同时施行Rex手术。9例便血患儿的便血症状较前明显好转。1例出生后黄疽和血清转氨酶升高患儿术后血清胆红素和转氨酶降至正常。1例血清转氨酶升高患儿术后恢复正常,1例低氧血症患儿术后血氧饱和度恢复正常。结论门体分流结扎术是治疗Ⅱ型Abernethy畸形的有效方法。Objective To investigate the feasibility and effectiveness of surgical ligation in the treatment of congenital extra-hepatic portosystemic shunt(Abernethy malformation)in children.Methods Among the 12 children with Abernethy malformation admitted at our hospital,9 cases for blood stools,2 cases for elevated transam inase level and jaundice,and 1 case for hypoxemia.Intraoperatively,if portal pressure was≤26 cm H20(1 cm H20=0.098 kPa)after clamping the shunt,than the shunt was ligated,when>26 cm H20,the portosystemic shunt was partially ligated and the shunt was completely ligated in a two stage.All patients were followed up for 5-70 months(mean:35.2 months).Results Six cases underwent the one stage ligation of portosystemic shunt,five cases underwent the two stage ligation and one case with partial ligation of portosystemic shunt.The symptoms of hematochezia relieved in 9 cases.The levels of blood bilirubin and transaminase returned to normal after operation in 2 cases with increased transaminase.The oxygen saturation returned to normal in 1 case with hypoxemia.Conclusion The surgical ligation of portosystemic shunt is an effective method to treat type Ⅱ Abernethy malformation.

关 键 词：动静脉畸形 结扎术 门静脉 

分 类 号：R726.5[医药卫生—儿科]