CAJ | 학술논문

目的初步探讨脾静脉-左肾上腺静脉分流术对儿童门静脉海绵样变所致门静脉高压症的疗效.方法总结8例儿童门静脉海绵样变致门静脉高压症七消化道出血病例的临床及随访资料,分析该手术的疗效.结果本组8例在分流术前后门静脉压力分别为(30±11)mm Hg和(22±7)mm Hg,两者相比差异有统计学意义,P＜0.01.术后随访6个月～5年,无死亡及再次发生上消化道出血病例,肝功能良好.术前外周血中三系下降的7例患儿术后血常规WBC计数为(7.64±4.46)×10~9/L,RBC计数为(4.54±0.97)×10~(12)/L,Hb为(133±5)g/L,PLT计数为(355.40±107.36)×10~9/L,与术前相比差异均有统计学意义,P＜0.05.术前1例PLT计数降低的患儿术后PLT计数为333×10~9/L,较术前显著升高.4例术后血氨升高,由术前的(18±7)μmol/L升高至术后的(60±17)μmol/L,两者相比差异有统计学意义,P＜0.05,但无1例发牛肝性脑病,且智力发育良好.消化道钡餐X线或胃镜检查提示6例食管胃底静脉曲张程度好转,血管超声显示吻合口无狭窄,血管内无血栓形成.结论脾-左肾上腺静脉分流术治疗儿童门静脉海绵样变所致门静脉高压症可获得良好的效果.
목적 초보탐토비정맥-좌신상선정맥분류술대인동문정맥해면양변소치문정맥고압증적료효.방법 총결8례인동문정맥해면양변치문정맥고압증칠소화도출혈병례적림상급수방자료,분석해수술적료효.결과 본조8례재분류술전후문정맥압력분별위(30±11)mm Hg화(22±7)mm Hg,량자상비차이유통계학의의,P＜0.01.술후수방6개월～5년,무사망급재차발생상소화도출혈병례,간공능량호.술전외주혈중삼계하강적7례환인술후혈상규WBC계수위(7.64±4.46)×10~9/L,RBC계수위(4.54±0.97)×10~(12)/L,Hb위(133±5)g/L,PLT계수위(355.40±107.36)×10~9/L,여술전상비차이균유통계학의의,P＜0.05.술전1례PLT계수강저적환인술후PLT계수위333×10~9/L,교술전현저승고.4례술후혈안승고,유술전적(18±7)μmol/L승고지술후적(60±17)μmol/L,량자상비차이유통계학의의,P＜0.05,단무1례발우간성뇌병,차지력발육량호.소화도패찬X선혹위경검사제시6례식관위저정맥곡장정도호전,혈관초성현시문합구무협착,혈관내무혈전형성.결론 비-좌신상선정맥분류술치료인동문정맥해면양변소치문정맥고압증가획득량호적효과.
Objective To evaluate the effect of spleno-left adrenal vein shunt for the treatment of portal hypertensive upper GI bleeding caused by portal vein cavernous transformation in children.Methods Spleno-left adrenal vein shunt was performed in 8 children with portal hypertension due to cavernous transformation.The clinical data was reviewed.Results Portal vein pressure decreased significantly from (30±11)mm Hg to(22±7) mm Hg after shunt.There was no mortality perioperatively and during the follow-up.There were no recurrent hemorrhage nor hepatic encephalopathy occurring in the follow-up and all the children have normal intelligence and normal liver function though blood ammonia level increased significantly from(18±7)μmol/L to (60±17)μmol/L in 4 cases.In 7 cases in which preoperative whole blood cell count significantly decreased,the postoperative WBC,RBC,Hb and PLT was (7.64 ±4.46)×10~9/L,(4.54±0.97)×10~(12)/L,(133±5) g/L and (355.40±107.36)×10~9/L respectively (all P ＜0.05).In one case suffering from preoperative low PLT count the postop PLT reached 333×10~9/L,which was significantly higher than that preoperatively.Esophageal varices ameliorated in 6 cases.No stenosis of anastomotic stoma and thrombosis developed.Conclusion Spleno-left adrenal vein shunt is an effective procedure to treat portal vein cavernous transformation induced portal hypertension in children.