CAJ | 학술논문

目的评估Rex-bypass shunt联合贲门周围血管离断术治疗小儿门静脉海绵样变性引起的肝前性门静脉高压症的疗效.方法回顾性分析2008年8月至2013年12月行Rex-bypass shunt联合贲门周围血管离断术的21例门静脉海绵样变性的患儿临床资料.男13例,女8例,年龄3～49岁,按照年龄分为A、B、C三组,术前完善门静脉系统彩色多普勒超声、CT门静脉造影(CTV)及其三维成像、肝功能等检查,留作术后随访对照,手术方式为Rex-bypass shunt搭桥术或转流术联合贲门周围血管离断术,存在脾大患儿同时行脾脏切除术或脾脏次全切除术(＜5岁患儿).结果无术中死亡病例,术后随访6～64个月,16例于搭桥或转流术后后1周内行B型超声检查示血管通畅,1例血管通而不畅,5例术后近期血栓形成,2例分别于3个月和6个月后检查复通,3例不通.17例胃镜检查食管胃底静脉曲张均已明显减轻,其中6例消失,8例仍有轻度静脉曲张,3例仍有中度静脉曲张.Fisher's Exact检验及配对秩和检验处理,术后肝功能可明显改善(P=0.042),早期手术优于延迟手术(四格表Pearson Chi-Square检验,P=0.001).结论 Rex-bypass shunt联合贲门周围血管离断术是安全有效的,可成为治疗小儿门静脉海绵样变性引起肝前性门静脉高压症的首选术式.
목적 평고Rex-bypass shunt연합분문주위혈관리단술치료소인문정맥해면양변성인기적간전성문정맥고압증적료효.방법 회고성분석2008년8월지2013년12월행Rex-bypass shunt연합분문주위혈관리단술적21례문정맥해면양변성적환인림상자료.남13례,녀8례,년령3～49세,안조년령분위A、B、C삼조,술전완선문정맥계통채색다보륵초성、CT문정맥조영(CTV)급기삼유성상、간공능등검사,류작술후수방대조,수술방식위Rex-bypass shunt탑교술혹전류술연합분문주위혈관리단술,존재비대환인동시행비장절제술혹비장차전절제술(＜5세환인).결과 무술중사망병례,술후수방6～64개월,16례우탑교혹전류술후후1주내행B형초성검사시혈관통창,1례혈관통이불창,5례술후근기혈전형성,2례분별우3개월화6개월후검사복통,3례불통.17례위경검사식관위저정맥곡장균이명현감경,기중6례소실,8례잉유경도정맥곡장,3례잉유중도정맥곡장.Fisher's Exact검험급배대질화검험처리,술후간공능가명현개선(P=0.042),조기수술우우연지수술(사격표Pearson Chi-Square검험,P=0.001).결론 Rex-bypass shunt연합분문주위혈관리단술시안전유효적,가성위치료소인문정맥해면양변성인기간전성문정맥고압증적수선술식.
Objective To evaluate the efficacies of Rex-bypass shunt plus paraesophagogastric devascularization for prehepatic portal hypertension (PHT) due to cavernomatous transformation of portal vein (CTPV) in children.Methods The clinical data of 21 children with prehepatic vascular hypertension undergoing Rex-bypass shunt plus paraesophagogastric devascularization were retrospectively analyzed.There were 13 males and 8 females with an age range of 3-49 years.According to age,they were divided into 3 groups after color Doppler ultrasound of portal vein system.Computed tomographic portal vein angiography (CTV),three dimensional imaging and liver function test were performed preoperatively.And the procedures were Rex-bypass shunt plus paraesophagogastric devascularization,splenectomy or subtotal splenectomy.Results There was no instance of intraoperative mortality.The follow-up period was 6-64 months.There were vascular bypass with blood flow (n =16),partial obstruction (n =1),thrombosis (n =5) and recanalization (n =2).Among 17 cases with esophageal and gastric varices,there were significant improvements,including complete remission (n =6),mild varicosity (n =8) and moderate varicosity (n =3).The results of Fisher's exact test and paired rank indicated improved hepatic function (P =0.042).Fourtable Pearson's Chi-square test indicated better efficacies of early over delayed operation.Conclusions Rex-bypass shunt plus pericardial devascularization is both safe and efficacious for prehepatic portal hypertension due to CTPV in children.