合并胡桃夹综合征的儿童肝内型门静脉高压行脾腔分流术1例  

Splenic shunt performed on a child with intrahepatic portal hypertension complicated with nutcracker syndrome

作　　者：邓富强[1] 温哲 DENG Fuqiang;WEN Zhe(Department of Pediatric Surgery,Meizhou People's Hospital,Meizhou,Guangdong 514000,China;Department of Hepatobiliary Surgery,Guangzhou Women and Children's Medical Center,Guangzhou,Guangdong 510000,China)

机构地区：[1]梅州市人民医院小儿外科,广东梅州514000 [2]广州市妇女儿童医疗中心肝胆外科,广东广州510000

出　　处：《安徽医药》2024年第8期1633-1635,I0003,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探索儿童肝内型门静脉高压的手术治疗经验。方法总结1例于2022年9月入住梅州市人民医院的儿童肝内型门静脉高压的病儿行远端脾-下腔静脉分流的治疗方案选择。结果病儿主诉呕血4 h。术前诊断为门静脉高压,食管静脉重度曲张破裂出血。病儿入院后予对症治疗,病情稳定后拟行Warren手术,术中发现肠系膜上动脉压迫左肾静脉并致其压力升高,故改行远端脾-下腔静脉分流。术后随访6个月,食管胃底静脉曲张减轻,脾亢改善,肝功能维持正常。结论儿童肝内型门静脉高压行选择性分流术时,在左肾静脉解剖异常或合并胡桃夹综合征,不能行Warren手术的情况下,可以选择远端脾-下腔静脉分流术,也可达到选择性分流手术的效果。Objective To explore the surgical treatment of intrahepatic portal hypertension in children.Methods The choice of treatment with distal splenic-inferior vena cava shunt in a child with intrahepatic portal hypertension admitted to Meizhou People's Hospital in September 2022 was summarized.Results The child complained of hematemesis for 4 h.Preoperative diagnosis:portal hypertension,severe esophageal vein rupture and bleeding.After admission,the child was given symptomatic treatment.After the condition was stable,Warren surgery was planned.During the operation,the superior mesenteric artery compressed the left renal vein and caused the pressure to increase,so the distal splenic-inferior vena cava shunt was changed.At 6 months postoperative follow-up,esophagogastric varices decreased,hypersplenic improved and liver function remained normal.Conclusion When elective shunt is performed with intrahepatic portal hypertension,distal spleno-vena cava shunt can be selected when the left renal vein has abnormal anatomy or nutcracker syndrome and Warren surgery cannot be performed,and the effect of elective shunt surgery can also be achieved.

关 键 词：高血压 门静脉 肾胡桃夹综合征 儿童 肝内型 Warren手术 脾腔分流术 

分 类 号：R726.5[医药卫生—儿科]