CAJ | 학술논문

目的：总结 Rex 分流术及 Warren 分流术治疗8例门静脉海绵样变的效果及并发症。方法2012年12月至2015年1月作者采用分流手术治疗门静脉海绵样变8例，其中 Rex 分流手术5例（2例为断流手术后出血复发），Warren 分流手术3例。Rex 分流术选取自身门静脉 Rex 窦与扩张的胃冠状静脉等做吻合，并在血管吻合前后测量门静脉压力，门静脉压不同程度地降低。Warren 分流术将游离脾静脉与左肾静脉相吻合，吻合前后均测门静脉压力。结果8例均获随访，随访时间6～31个月，患儿生长发育如同龄儿，均未出现门脉高压性脑病；1例于术后16个月再出血1次，后未再出血，7例无再发出血；1例术后出现肠系膜静脉血栓形成，经溶栓及抗凝治疗后痊愈；1例行脾动脉结扎术患儿术后出现脾梗死，间断发热1个月。结论分流手术治疗门脉海绵样变，预防消化道出血效果良好，手术有一定的并发症。
목적：총결 Rex 분류술급 Warren 분류술치료8례문정맥해면양변적효과급병발증。방법2012년12월지2015년1월작자채용분류수술치료문정맥해면양변8례，기중 Rex 분류수술5례（2례위단류수술후출혈복발），Warren 분류수술3례。Rex 분류술선취자신문정맥 Rex 두여확장적위관상정맥등주문합，병재혈관문합전후측량문정맥압력，문정맥압불동정도지강저。Warren 분류술장유리비정맥여좌신정맥상문합，문합전후균측문정맥압력。결과8례균획수방，수방시간6～31개월，환인생장발육여동령인，균미출현문맥고압성뇌병；1례우술후16개월재출혈1차，후미재출혈，7례무재발출혈；1례술후출현장계막정맥혈전형성，경용전급항응치료후전유；1례행비동맥결찰술환인술후출현비경사，간단발열1개월。결론분류수술치료문맥해면양변，예방소화도출혈효과량호，수술유일정적병발증。
Objetive the outcomes and possible complications of surgical procedures of Rex shunt and Warren shunt in 8 cases of cavernous transformation of portal vein. Methods 8 cases who underwent the shunt surgery for cavernous transformation of portal vein from December 2012 to January 2015 were reviewed, including 5 patients having Rex shunt (2 cases of them had recurrent bleeding after devascularization proce-dures),and 3 having Warren shunt.All cases had recurrent upper gastrointestinal hemorrhage(more than twice per year).Upper gastrointestinal contrast studies helped delineate the extent of esophageal and gastric varices and cavernous transformation of portal vein was confirmed by color Doppler ultrasound and CT.In Rex proce-dures,the isolated coronary veins were sewn to the intrahepatic portalvein in the recessus of Rex,meanwhile, the portal vein pressures were measured during vascular anastomosis to assure the relief of portal hypertension after the process.While in Warren shunt,the varices were decompressed by allowing them to drain via the splenic vein into the left renal vein,the portal vein pressures were obtained as well. Results Patients were followed up for 6 to 31 months.Growth and development was the same for all patients within the same age group,and no cases present with encephalopathy;1 case had recurrent bleeding after 16 months of the opera-tions;mesenteric venous thrombosis occurred in one case and was cured through thrombolysis and anticoagula-tion therapy;1 case with infraction of spleen had fever for one month.Conclusions Shunt precedures are effec-tive to treat cavernous transformation of portal vein and prevent the gastrointestinal bleeding while with limited complications.