摘要
目的探讨肝外门静脉高压患儿术中肝外门静脉造影的表现及与造影结果相关的因素。方法2008年2月至2017年10月,107例患儿(男62例,女45例)因上消化道出血或脾大、脾亢就诊于首都儿科研究所普外科,行超声和CT检查诊断为"门静脉海绵样变",行手术治疗(99例Rex手术,7例Warren手术和1例腹腔镜脾血管结扎术)。术中行肠系膜上静脉造影明确门静脉系统情况。根据肝外门静脉造影的表现,将患儿分为以下组:胃冠状静脉显影组和未显影组,脾静脉显影组和未显影组,门静脉海绵样变表现为"棉花团"状组和可见侧支血管组,肝内门静脉显影组和未显影或显影不良组。比较各组间手术前后门静脉压力、术前食管静脉曲张发生率、发病时间、术后再出血发生率、手术前后脾脏大小和术时年龄的差异。比较胃冠状静脉显影组和未显影组采用胃冠状静脉-门静脉左支分流术的比例差异。比较门静脉海绵样变表现与胃冠状静脉、脾静脉和肝内门静脉显影与否的相关性。结果术后随访3~120个月,平均48.1个月。门静脉海绵样变为"棉花团"状表现者的术前食管静脉曲张率、发病时间、术后脾脏大小和术时年龄显著低于可见侧支静脉者(P<0.05)。胃冠状静脉显影者的术前食管静脉曲张率显著高于未显影者,二者有显著相关性(P=0.002)。肝内门静脉显影良好者的发病时间、手术前后的脾长、术时年龄显著低于门静脉显影不良或未显影者(P<0.05)。门静脉海绵样变的表现与胃冠状静脉和肝内门静脉的显影与否有显著相关性:门静脉海绵样变为"棉花团"状表现者的胃冠状静脉显影比例显著低于可见侧支静脉者(P=0.000);门静脉海绵样变为"棉花团"状表现者的肝内门静脉显影比例显著高于可见侧支静脉者(P=0.003)。胃冠状静脉显影与采用胃冠状静脉-门静脉左支分流术有显著相关性(P=0.000)。结论门静脉�
Objective To explore the findings of portal angiography in children with extrahepatic portal hypertension and factors associated with morphology of portal venous system. Methods From February 2008 to October 2017, 107 patients (62 boys and 45 girls) with upper gastrointestinal bleeding or splenomegaly and hypersplenism were admitted. Cavernous transformation of portal vein was diagnosed by ultrasound and computed tomography (CT), The procedures were Rex shunt (n=99), Warren shunt (n=7) and laparoscopic splenic vessel ligation (n=1). Intraoperative superior mesenteric venography was employed for determining the morphology of portal venous system. According to the morphology of portal vein, they were divided into groups with and without a visible gastric coronary vein;groups with and without a visible splenic vein;group with appearance of "cotton mass" and group with visible collateral veins in portal cavernoma;groups with and without a decent visible intrahepatic portal vein. The preoperative and postoperative portal pressure, preoperative incidence of esophageal varices, time of onset, incidence of postoperative rebleeding, preoperative and postoperative splenic sizes and operative age were compared among the groups. The proportion of children undergoing gastroportal bypass was compared. And the correlations between appearance of cavernous transformation of portal vein and conditions of coronary vein, splenic vein and intrahepatic portal vein were analyzed. Results The average follow-up duration was 48.1(3-120) months. The preoperative incidence of esophageal varices, time of onset, postoperative splenic size and operative age were significantly lower in the group with appearance of "cotton mass" than those of the group with visible collateral veins (P<0.05). The incidence of preoperative esophageal varices in the group with visible gastric coronary vein was significantly higher than that in the group without visible gastric coronary vein. A significant correlation existed between visible coronary vein and esopha
作者
张金山
侯文英
李龙
Zhang Jinshan;Hou Wenying;Li Long(Graduate School of Peking Union Medical College, Beijing 100730, China;Department of General Surgery, Capital Institute of Pediatrics, Beijing 100020, China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2019年第8期697-702,共6页
Chinese Journal of Pediatric Surgery
基金
国家自然科学基金(81770595)
首都卫生发展科研专项(首发2016-4-2104)
北京市医管局“青苗计划”(QML20161304).
