经肠系膜上静脉入路的胰后隧道建立在儿童门静脉海绵样变肝门解剖中的作用  

Role of retropancreatic tunnel established by superior mesenteric vein-approach in a child with cavernous transformation of the portal vein during Rex bypass

作　　者：罗洋 彭赟 吴耀星 谢小龙 王琦[1] 吕勇 李可为[1] 向波[1] LUO Yang;PENG Yun;WU Yaoxing;XIE Xiaolong;WANG Qi;LÜYong;LI Kewei;XIANG Bo(Department of Pediatric Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院小儿外科,成都610041

出　　处：《中国普外基础与临床杂志》2024年第8期897-902,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省科技计划项目重点研发项目(项目编号:2021YFQ0063);四川大学高校基本科研业务费-“从0到1”创新研究项目(项目编号:2023SCUH0038)。

摘　　要：目的 总结经肠系膜上静脉入路的胰后隧道建立在儿童门静脉海绵样变肝门解剖中的临床运用经验。方法 回顾性分析2023年9月笔者所在医院收治的1例儿童门静脉海绵样变患者的临床资料。笔者团队将提出的经肠系膜上静脉入路的胰后隧道建立方案运用到该患儿的肝门解剖中。结果 该4岁男性门静脉海绵样变患儿术中通过经肠系膜上静脉入路的胰后隧道的建立,快速、安全地定位门静脉,从而简化肝门解剖,成功完成胰腺后方Rex搭桥。手术总时间约8 h,术中出血约60 mL(包括血管吻合时放血)。经术后3个月随访,患儿恢复良好,搭桥血管通畅,门静脉高压表现得到纠正。结论 笔者所在团队提出的经肠系膜上静脉入路建立胰后隧道的手术策略可以简化儿童门静脉海绵样变的肝门解剖流程,从而更迅速、安全地寻找到血管吻合部位。Objective To summarize the clinical experience of retropancreatic tunnel established by superior mesenteric vein-approach in a child with cavernous transformation of the portal vein(CTPV)during Rex bypass.Method The retropancreatic tunnel was created by the superior mesenteric vein-approach during Rex bypass in a child with CTPV who was admitted to our hospital in September,2023.Clinical data were retrospectively analyzed.Results For the 4-year-old male child who was diagnosed with CTPV,after the establishment of the retropancreatic tunnel by superior mesenteric vein-approach,the portal vein was quickly identified,thus simplifying the portal dissection.The operation time of Rex bypass was about 8 hours,and intraoperative blood loss was about 60 mL.After a 3-month follow-up,the child recovered well with patent bypass vessels.Conclusion The surgical strategy proposed by our team can simplify the Rex bypass,resulting in more rapid and safe access to the vascular anastomosis site.

关 键 词：门静脉海绵样变 胰后隧道 肠系膜上静脉 门静脉 

分 类 号：R726.5[医药卫生—儿科]