摘要
目的探讨Rex手术治疗儿童肝外门静脉梗阻(extrahepatic portal venous obstruction,EHPVO)的远期疗效。方法回顾性分析2014年10月至2022年1月在广州市妇女儿童医疗中心接受Rex手术治疗的130例次(128例)EHPVO患儿的临床资料。其中男81例,女49例;手术年龄0.5~16.0岁,中位年龄6.1岁。首次Rex手术114例,再次Rex手术16例(其中2例在本院初次手术)。观察患儿临床表现,采用腹部B型超声、增强CT评估脾脏大小及分流血管通畅情况,记录血常规、血生化、凝血功能、血氨等化验结果,行胃镜检查了解食管胃底静脉曲张程度。采用χ^(2)检验、配对t检验及Wilcoxon秩和检验对术前与术后的数据进行统计分析。结果所有患儿均顺利完成Rex手术,术后病理活检均无肝硬化或肝纤维化。患儿术后均获得随访,平均随访时间32.6个月(12~98个月)。采用的搭桥血管包括颈内静脉110例、腹腔内血管20例(胃左静脉8例、脾静脉4例、肠系膜下静脉3例、胃网膜静脉2例、门静脉1例、脾脏后粗大分流血管1例、脾静脉拼接曲张血管1例)。术后发生血管并发症30例(23.08%,30/130),包括搭桥血管栓塞12例(9.23%,12/130),吻合口狭窄18例(13.85%,18/130)。吻合口狭窄行介入治疗17例,治疗成功16例。搭桥血管总体通畅率为90.77%,其中颈内静脉通畅率为97.27%,腹腔内血管通畅率为55.00%。颈内静脉血管并发症发生率为12.73%(14/110),腹腔内血管为80.00%(16/20)。Rex术后搭桥血管通畅的患儿门静脉高压症状显著改善,脾功能亢进、脾大明显缓解,约60%的患儿食管胃底静脉曲张完全消失,1/3的患儿较术前减轻。再次Rex手术采用颈内静脉做搭桥血管12例,肠系膜下静脉2例,胃左静脉1例,脾静脉拼接曲张血管1例。术后再发搭桥血管栓塞2例,吻合口狭窄4例,4例狭窄患儿均经介入治疗成功。再次Rex手术总体血管通畅率为87.50%,颈内静脉通畅率为91.67%。再次Rex术后搭�
Objective To explore the long-term efficacy of Rex surgery for extrahepatic portal venous obstruction(EHPVO)in children.Methods Clinical data of 130 cases(128 children)of children with EHPVO treated with Rex surgery from October 2014 to January 2022 were retrospectively analyzed.There were 81 males and 49 females;the age at surgery ranged from 0.5 to 16 years,with a median age of 6.1 years.There were 114 cases of initial Rex surgery and 16 cases of redo Rex surgery(2 of them were operated for the first time).Clinical manifestations were recorded,splenic size and patency of bypass vessel were evaluated by abdominal ultrasound and enhanced computed tomography(CT).The relevant laboratory results of complete blood count,biochemistry,coagulation function and blood ammonia were analyzed and gastroscopy was performed for evaluating the severity of esophagogastric fundic varices.The preoperative and postoperative data were statistically compared by χ^(2),paired t and Wilcoxon rank-sum tests.Results All of the children successfully completed Rex procedure and none had histological cirrhosis or liver fibrosis.All children were followed up after surgery,with a mean follow-up time of 32.6(12-98)months.The types of bypass vessels included internal jugular vein(n=110)and intra-abdominal vessels(n=20),including left gastric vein(n=8);splenic vein(n=4);inferior mesenteric vein(n=3);gastroretinal vein(n=2);portal vein(n=1);posterior splenic collateral vessel(n=1);splicing of splenic vein with collateral vessel(n=1).Postoperative vascular complications occurred(n=30,23.08%),including vascular occlusion(n=12,9.23%)and anastomotic stenosis(n=18,13.85%).Interventional therapy for anastomotic stenosis was performed in 17 cases(94.44%)with a success rate of 94.12%(16/17).The overall patency rate of bypass vessels was 90.77%,including 97.27%for internal jugular vein and 55.00%for intra-abdominal vessels.The vascular complication rate was 12.73%(14/110)for internal jugular vessels and 80.00%(16/20)for intra-abdominal vessels.The symptom
作者
王杰钦
温哲
宁禹
梁奇峰
刘涛
梁鉴坤
刘珍银
王红英
白晓玲
游辅宇
Wang Jieqin;Wen Zhe;Ning Yu;Liang Qifeng;Liu Tao;Liang Jiankun;Liu Zhenyin;Wang Hongying;Bai Xiaoling;You Fuyu(Department of Hepatobiliary Surgery,Guangzhou Women&Children's Medical Center,Guangdong Provincial Clinical Research Center for Children's Health,Guangzhou 510623,China;Department of Interventional Therapy,Guangzhou Women&Children's Medical Center,Guangdong Provincial Clinical Research Center for Children's Health,Guangzhou 510623,China;Department of Ultrasonography,Guangzhou Women&Children's Medical Center,Guangdong Provincial Clinical Research Center for Children's Health,Guangzhou 510623,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2023年第6期501-507,共7页
Chinese Journal of Pediatric Surgery
基金
广东省科技攻关计划项目(2014A020212026)
广州市临床特色技术项目(2019TS58)。
关键词
高血压
门静脉
肝外门静脉梗阻
门静脉海绵样变
Rex手术
儿童
Hypertension,portal
Extrahepatic portal venous obstruction
Cavernous transformation of portal vein
Rex surgery
Child
