BACKGROUND The Rex shunt was widely used as the preferred surgical approach for cavernous transformation of the portal vein(CTPV)in children that creates a bypass between the superior mesenteric vein and the intrahepa...BACKGROUND The Rex shunt was widely used as the preferred surgical approach for cavernous transformation of the portal vein(CTPV)in children that creates a bypass between the superior mesenteric vein and the intrahepatic left portal vein(LPV).This procedure can relieve portal hypertension and restore physiological hepatopetal flow.However,the modified procedure is technically demanding because it is difficult to make an end-to-end anastomosis of a bypass to a hypoplastic LPV.Many studies reported using a recanalized umbilical vein as a conduit to resolve this problem.However,the feasibility of umbilical vein recanalization for a Rex shunt has not been fully investigated.AIM To investigate the efficacy of a recanalized umbilical vein as a conduit for a Rex shunt on CTPV in children by ultrasonography.METHODS A total of 47 children who were diagnosed with CTPV with prehepatic portal hypertension in the Second Hospital,Cheeloo College of Medicine,Shandong University,were enrolled in this study.Fifteen children received a recanalized umbilical vein as a conduit for a Rex shunt surgery and were enrolled in group I.Thirty-two children received the classic Rex shunt surgery and were enrolled in group II.The sonographic features of the two groups related to intraoperative and postoperative variation in terms of bypass vessel and the LPV were compared.RESULTS The patency rate of group I(60.0%,9/15)was significantly lower than that of group II(87.5%,28/32)7 d after(on the 8th d)operation(P<0.05).After clinical anticoagulation treatment for 3 mo,there was no significant difference in the patency rate between group I(86.7%,13/15)and group II(90.6%,29/32)(P>0.05).Moreover,3 mo after(at the beginning of the 4th mo)surgery,the inner diameter significantly widened and flow velocity notably increased for the bypass vessels and the sagittal part of the LPV compared to intraoperative values in both shunt groups(P<0.05).However,there was no significant difference between the two surgical groups 3 mo after surgery(P>0.05).CONCLUSION 展开更多
目的总结Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变的经验与疗效。方法回顾性分析2012年8月至2019年7月在安徽省儿童医院行Rex分流联合断流、脾动脉结扎术治疗的16例门静脉海绵样变、门静脉高压症患儿临床资料及随访结果。...目的总结Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变的经验与疗效。方法回顾性分析2012年8月至2019年7月在安徽省儿童医院行Rex分流联合断流、脾动脉结扎术治疗的16例门静脉海绵样变、门静脉高压症患儿临床资料及随访结果。结果15例成功手术,分流前门静脉测压28.3~45.8 cm H 2O,平均(32.6±5.4)cm H 2O,分流后显著下降为17.2~27.8 cm H 2O,平均(23.4±3.7)cmH 2O,分流前后门静脉压力差异有统计学意义(P<0.01)。术后均恢复出院。1例术中吻合血管不通畅加行Warren术,术后脾肾静脉吻合口血栓形成,介入治疗效果不显著,自动出院后死亡。成功手术的15例患儿术后随访6个月至6年,平均随访31.5个月,3例术后有消化道出血复发,药物止血均较易控制,其中2例均复发1次,1例复发2次后未再出血,但出现脾大、脾功能亢进,术后5年行脾切除术。15例均生长发育良好。结论Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变所致门静脉高压症效果确切。展开更多
文摘BACKGROUND The Rex shunt was widely used as the preferred surgical approach for cavernous transformation of the portal vein(CTPV)in children that creates a bypass between the superior mesenteric vein and the intrahepatic left portal vein(LPV).This procedure can relieve portal hypertension and restore physiological hepatopetal flow.However,the modified procedure is technically demanding because it is difficult to make an end-to-end anastomosis of a bypass to a hypoplastic LPV.Many studies reported using a recanalized umbilical vein as a conduit to resolve this problem.However,the feasibility of umbilical vein recanalization for a Rex shunt has not been fully investigated.AIM To investigate the efficacy of a recanalized umbilical vein as a conduit for a Rex shunt on CTPV in children by ultrasonography.METHODS A total of 47 children who were diagnosed with CTPV with prehepatic portal hypertension in the Second Hospital,Cheeloo College of Medicine,Shandong University,were enrolled in this study.Fifteen children received a recanalized umbilical vein as a conduit for a Rex shunt surgery and were enrolled in group I.Thirty-two children received the classic Rex shunt surgery and were enrolled in group II.The sonographic features of the two groups related to intraoperative and postoperative variation in terms of bypass vessel and the LPV were compared.RESULTS The patency rate of group I(60.0%,9/15)was significantly lower than that of group II(87.5%,28/32)7 d after(on the 8th d)operation(P<0.05).After clinical anticoagulation treatment for 3 mo,there was no significant difference in the patency rate between group I(86.7%,13/15)and group II(90.6%,29/32)(P>0.05).Moreover,3 mo after(at the beginning of the 4th mo)surgery,the inner diameter significantly widened and flow velocity notably increased for the bypass vessels and the sagittal part of the LPV compared to intraoperative values in both shunt groups(P<0.05).However,there was no significant difference between the two surgical groups 3 mo after surgery(P>0.05).CONCLUSION
文摘目的总结Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变的经验与疗效。方法回顾性分析2012年8月至2019年7月在安徽省儿童医院行Rex分流联合断流、脾动脉结扎术治疗的16例门静脉海绵样变、门静脉高压症患儿临床资料及随访结果。结果15例成功手术,分流前门静脉测压28.3~45.8 cm H 2O,平均(32.6±5.4)cm H 2O,分流后显著下降为17.2~27.8 cm H 2O,平均(23.4±3.7)cmH 2O,分流前后门静脉压力差异有统计学意义(P<0.01)。术后均恢复出院。1例术中吻合血管不通畅加行Warren术,术后脾肾静脉吻合口血栓形成,介入治疗效果不显著,自动出院后死亡。成功手术的15例患儿术后随访6个月至6年,平均随访31.5个月,3例术后有消化道出血复发,药物止血均较易控制,其中2例均复发1次,1例复发2次后未再出血,但出现脾大、脾功能亢进,术后5年行脾切除术。15例均生长发育良好。结论Rex分流联合断流、脾动脉结扎术治疗小儿门静脉海绵样变所致门静脉高压症效果确切。
