CAJ | 학술논문

目的总结过去8年采用保留脾脏、远端脾静脉肾静脉分流手术(Warren手术)治疗小儿门脉高压的效果.方法本组患儿36例,年龄3～15岁,男12例,女24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29例,Carolis病合并肝纤维化2例,先天性肝纤维化5例.Child-pugh评分均为A级(5～7分),脾静脉的直径6.5～12.2 mm,平均为(8.6±2.3)mm.术中首先经小肠系膜山级静脉和脾静脉分支行静脉压力测定及造影.然后将整个脾静脉游离,距肠系膜上静脉0.5 cm处切断,与左肾静脉端一侧吻合.结果 36例患儿实施远端脾-肾分流手术,平均手术时间3.1 h,手术失血10～30 ml;无术中需输血者.分流前肠系膜上静脉压力为26.5～33.3 cmH2O,平均值为(28.9±4.8)cmH2O,脾静脉压力为26.2～33.5 cmH2O,平均值为(28.5±4.5)cmH2O;分流后肠系膜上静脉压力为17.2～26.4cmH2O,平均值为(23.8±3.9)cmH2O,脾静脉压力为10.5～16.cmH2O,平均值为(13.5±4.7)cmH2O,分流手术后脾静脉压力明显降低(P＜0.01).手术后2例患儿出现乳糜腹,保守治疗1个月后自然消失.随诊6～94个月,1例(1/36)手术后3个月吻合口闭合,行脾切除和断流手术.其他35例随访期内无再发消化道出血者,脾脏尽管比正常同龄儿童稍大,但均回缩,且血红蛋白、白细胞、血小板均在正常水平,未出现脑病者.B超检查,脾肾静脉吻合口通畅.结论 Warren手术是治疗小儿肝外型门静脉高压的有效途径之一,预防消化道再出血和脾功能亢进效果可靠,同时具有保留脾脏,贲门胃底血流可通过胃短动脉流向脾静脉使该区域保持低压状态,不降低门静脉灌注压力等优点.
목적 총결과거8년채용보류비장、원단비정맥신정맥분류수술(Warren수술)치료소인문맥고압적효과.방법 본조환인36례,년령3～15세,남12례,녀24례.환인표현위반복소화도출혈,식관정맥곡장,비공능항진.문정맥주간정해면두양개변29례,Carolis병합병간섬유화2례,선천성간섬유화5례.Child-pugh평분균위A급(5～7분),비정맥적직경6.5～12.2 mm,평균위(8.6±2.3)mm.술중수선경소장계막산급정맥화비정맥분지행정맥압력측정급조영.연후장정개비정맥유리,거장계막상정맥0.5 cm처절단,여좌신정맥단일측문합.결과 36례환인실시원단비-신분류수술,평균수술시간3.1 h,수술실혈10～30 ml;무술중수수혈자.분류전장계막상정맥압력위26.5～33.3 cmH2O,평균치위(28.9±4.8)cmH2O,비정맥압력위26.2～33.5 cmH2O,평균치위(28.5±4.5)cmH2O;분류후장계막상정맥압력위17.2～26.4cmH2O,평균치위(23.8±3.9)cmH2O,비정맥압력위10.5～16.cmH2O,평균치위(13.5±4.7)cmH2O,분류수술후비정맥압력명현강저(P＜0.01).수술후2례환인출현유미복,보수치료1개월후자연소실.수진6～94개월,1례(1/36)수술후3개월문합구폐합,행비절제화단류수술.기타35례수방기내무재발소화도출혈자,비장진관비정상동령인동초대,단균회축,차혈홍단백、백세포、혈소판균재정상수평,미출현뇌병자.B초검사,비신정맥문합구통창.결론 Warren수술시치료소인간외형문정맥고압적유효도경지일,예방소화도재출혈화비공능항진효과가고,동시구유보류비장,분문위저혈류가통과위단동맥류향비정맥사해구역보지저압상태,불강저문정맥관주압력등우점.
Objective To review our experience with Warren shunt and to define its role in the management of variceal bleeding.Methods From October 1999 to August 2007,36 children with varieeal bleeding underwent Warren shunt operation.The age ranged from 3 tO 15 years (mean 8.2 years).29 patients suffered from cavernomatous portal vein,2 Carolis disease with hepatic fibrosis and the other 5 congenital hepatic fibrosis.The mean diameter of the splenic vein was 8.6±2.3 mm(6.5～12.2 mm).Results The distal splenorenal shunt was performed in the 36 cases.The mean op-erating time was 3.1 hours without necessity for blood transfusion.There was no operative mortality.The pre-shunt pressures of portal vein and splenic vein were 28.9±4.8 cmH2O(26.5～33.3 cmH2O)and(28.5±4.5)cmH2O(26.2～33.5 cmH2O)respectively.However after shunting,the pressures decreased to 23.8±3.9cmH2O(17.2～26.4 cmH2O)and 3.5±4.7 cmH2O(10.5～16.1 cmH2Ore-spectively.The pressure of the splenic vein after the operation was significantly decreased than that before the operation,P<O.01.One patient has anastomosic stricture and underwent splenectomy and branch ligation 3 month after the shunL The remaining 35 patients were alive at a median follow-up of 53 months(range 6 to 94 months)without evidences of recurrent gastrointestinal bleeding,hyper-splenism or encephalopathy.Conclusions The distal splenorenal shunt is a safe and effective therapy for children with portal hypertension.