CAJ | 학술논문

目的探讨利用门静脉属支向肝内门静脉矢状部搭桥(Rex手术)治疗儿童非肝硬化门脉高压的方法及效果.方法治疗门静脉海绵样变患儿52例,其中断流手术后再发反复消化道出血8例.患儿均采用扩张静脉分支的肠系膜上静脉系统建立向肝内门静脉矢状部分流.结果患儿年龄1.4～12岁,平均3.7岁.术后随访1.5 ～5年,48例未再发消化道出血,有效率92.3％.复发组分流术后肠系膜上静脉压力(27.6 ±3.2) cmH2O(1 cmH2O =0.098 kPa)显著高于非复发组(23.5±3.1) cmH2O,分流前后压差明显较小[(5.7± 1.8)cmH2O比(11.7 ±3.3)cmH2O],P＜0.05.结果表明分流压力下降幅度小,是手术效果不佳的早期表现.结论利用患儿门静脉属支向肝内门静脉矢状部搭桥建立分流安全有效.分流手术前后肠系膜上静脉的压力差可做为手术成功的早期判定指标.
목적 탐토이용문정맥속지향간내문정맥시상부탑교(Rex수술)치료인동비간경화문맥고압적방법급효과.방법 치료문정맥해면양변환인52례,기중단류수술후재발반복소화도출혈8례.환인균채용확장정맥분지적장계막상정맥계통건립향간내문정맥시상부분류.결과 환인년령1.4～12세,평균3.7세.술후수방1.5 ～5년,48례미재발소화도출혈,유효솔92.3％.복발조분류술후장계막상정맥압력(27.6 ±3.2) cmH2O(1 cmH2O =0.098 kPa)현저고우비복발조(23.5±3.1) cmH2O,분류전후압차명현교소[(5.7± 1.8)cmH2O비(11.7 ±3.3)cmH2O],P＜0.05.결과표명분류압력하강폭도소,시수술효과불가적조기표현.결론 이용환인문정맥속지향간내문정맥시상부탑교건립분류안전유효.분류수술전후장계막상정맥적압력차가주위수술성공적조기판정지표.
Objective The Rex shunt has been used to treat children with extrahepatic portal hypertension by creating a venous bypass between the superior mesenteric vein and the left portal vein to circumvent the extrahepatic portal venous obstruction.This retrospective study aimed to analyse our results in the use of this novel approach.Methods 52 patients with cavernous transformation and obstructed main portal veins were treated by Rex shunts.Results The age of children was 1.4 ～ 12 year,the mean age was 3.7 years.The patients were followed up from 1.5 to 5 years.In 48 patients,there was no recurrence of gastrointestinal bleeding after surgery making an efficacy rate of 92.3％.In the recurrence group,the postoperative venous pressure in the superior mesenteric vein was (27.6 ± 3.2) cmH2O (1 cmH2O =0.098kPa) which was significantly higher than the non-recurrence group (23.5 ± 3.1)cmH2O.The difference between the pre-and post-Rex shunting was significantly lower in the recurrence group (5.7 ± 1.8)cmH2O than the non-recurrence group (11.7 ± 3.3) cmH2 O,P ＜ 0.05.Thus,a low reduction in postoperative pressure was an early manifestation of poor prognosis.Conclusions The Rex shunt was safe and efficacious.The degree of reduction in postoperative venous pressure in the superior mesenteric vein could be used to predict recurrence of gastrointestinal bleeding.