Rex分流术治疗小儿肝前性门静脉高压症5例临床分析

摘要

Objective To study the therapeutic efficacy of Rex shunt in treating pediatric patients with prehepatic portal hypertension (PHPH).Methods Five children with PHPH who were admitted from October 2014 to May 2015 were reviewed.There were three boys and two girls,with age ranging from 50 to 95.5 months [(75.8 ± 1.9) months].They all suffered from recurrent upper gastrointestinal (GI) bleeding.Their red blood cell (RBC),white blood cell (WBC) and platelet (PLT) counts were decreased,but laboratory findings revealed no liver dysfunction.Ultrasound and CT scan diagnosed cavernous transformation of portal vein (CTPV) and splenomegaly.The mean splenic length was (42.8 ± 8.2) cm.Indirect portal venography revealed patent left portal vein.All patients underwent Rex shunt and were followed up for 3 ～ 7 months.Results The mean duration of operation was (566.0 ± 39.7) min.Intraoperative bleeding varied from 10 to 50 ml.The portal pressure significantly decreased after surgery from [(25.6 ± 1.5) mmHg,1 mmHg =0.133 kPa] preoperatively to (19.2 ± 3.3) mmHg postoperatively (P ＜ 0.05).Portal venography indicated patent left portal vein after the Rex shunt.The postoperative course was uneventful in the five patients with a mean hospital stay of (26 ± 9.3) days.There was no further GI bleeding.The RBC,WBC and PLT counts increased.Ultrasound indicated patent anastomotic stomas and decreased splenic size.Conclusion A Rex shunt in treating patients with PHPH is safe,feasible and efficacious.%目的 探讨肠系膜上静脉-门静脉左支分流术(Rex分流术)治疗小儿肝前性门静脉高压症的临床疗效.方法 2014年10月至2015年5月本院共收治5例肝前性门静脉高压症患儿.年龄为50 ～95.5个月,平均(75.8±1.9)个月.其中男性3例,女性2例.5例患儿均有反复上消化道出血(呕血、便血)病史.术前红细胞、白细胞、血小板有不同程度降低;肝功能各项指标均正常.术前B超及CT均提示门静脉海绵样变性,脾脏增大,平均厚度[n=5,(42.8 ±8.2)cm];间接门静脉造影示门静脉左支开放,无狭窄及变异.手术采用腹部正中纵行切口过脐.开腹探查后测定肠系膜上静脉压力,并行门脉造影,确认门静脉左支开放.分离矢状部肝组织,游离门静脉左支.游离左颈内静脉,将桥血管置于肠系膜上静脉和门静脉左支处行两个端侧吻合.再次测定肠系膜上静脉压力,行血管造影.术后随访3～7个月.结果 5例手术均获成功,平均手术时间(566.0±39.7)min,出血10～ 50 ml.分流前门静脉压力为[(25.6±1.5) mmHg,1 mmHg=0.133 kPa],分流后降至(19.2±3.3) mmHg(P＜0.05);分流术后血管造影示血管吻合口通畅无狭窄.平均住院时间为(26.0±9.3)d.随访期间患儿无呕血、便血发生,红细胞、白细胞和血小板计数均较术前升高,肝功能各项指标正常.B超示血管吻合口通畅,脾脏长径、厚度均较术前缩小.结论 Rex分流术治疗小儿肝前性门静脉高压症安全可行、效果良好.