摘要
目的 探讨保留脾脏、远端脾静脉肾静脉分流手术（Warren手术）治疗小儿门脉高压症的临床效果.方法 1999年10月至2012年12月,我们收治门脉高压症患儿50例,年龄3～15岁.男18例,女32例.患儿表现为反复消化道出血,食管静脉曲张,脾功能亢进.门静脉主干呈海绵窦样改变36例,Carolis病合并肝纤维化3例,先天性肝纤维化9例,门静脉发育不良1例,门静脉海绵样变Rex术后复发1例.Child-pugh评分均为A级（5～7分）,脾静脉直径6.0 ～ 15.0 mm,平均（9.8±2.2）mm.术中先经小肠系膜Ⅲ级静脉和脾静脉分支行静脉压力测定及造影,将脾静脉游离,于距肠系膜下静脉0.5 cm处切断,与左肾静脉端-侧吻合.结果 所有患儿实施远端脾-肾分流手术,手术时间255～ 370 min,平均手术时间232 min,术中失血10～ 30 mL.分流后门静脉和脾静脉压力均下降,门静脉压力分流后较分流前显著降低（P=0.026）;脾静脉压力分流后较分流前明显降低（P =0.007）.迄今为止随访时间跨度为0.5～11年.随访期间,患儿脾脏缩小,血红蛋白、白细胞、血小板恢复正常,无一例出现脑病.B超检查显示49例脾肾静脉吻合口通畅,1例术后1个月发现脾肾吻合口闭合,经再次手术治疗痊愈.结论 Warren手术治疗小儿门脉高压症效果显著,能有效降低小儿门脉高压术后食管静脉曲张再出血的发生率,保证入肝血流,减少肝性脑病的发生,是治疗小儿门脉高压症较理想的术式.
Objetive To investigate the results of Warren＇ s operation in the treatment of portal hypertension in children.Methods From October 1999 to December 2012,50 children with variceal bleeding underwent Warren shunt operation.The age ranged from 3 to 15 years.36 patients suffered from cavemomatous portal vein,3 Carolis disease with hepatic fibrosis and 9 congenital hepatic fibrosis.The diameter of the splenic vein was 6.0-15.0 nun（mean：9.8 ± 2.2mm）.The Warren＇ s operation was performed in all children.Results The mean operating time was 232 min.There was no operative mortality.The post-shunt pressures of portal vein and splenic vein were decreased.The post-shunt pressure of portal vein was significantly lower than that pre-operatively （P =0.026）.The pressure of the splenic vein after the operation was significantly decreased than that before the operation （P =0.007）.All children were followed up from 0.5 to 11 years after surgery.There is no evidence of recurrent gastrointestinal bleeding,hypersplenism or encephalopathy in 49 patients.One patient suffered from anastomotic stricture and underwent splenectomy and branch ligation 1 month after the shunt.Conclusions The Warren shunt is a safe and effective operation for children with portal hypertension.
出处
《临床小儿外科杂志》
CAS
2014年第1期26-29,共4页
Journal of Clinical Pediatric Surgery
关键词
高血压
门静脉
脾肾分流术
外科
儿童
Hypertension, Portal
Splenorenal Shunt,Surgical
Child
