儿童门静脉高压Rex手术后血管并发症分析

目的:探讨以颈内静脉(internal jugular vein, IJV)作为搭桥血管的Rex手术术后血管并发症的发生原因和预防策略。方法:回顾性分析自2014年10月至2019年8月54例接受初次Rex手术(采用IJV作为搭桥血管)治疗肝前性门静脉高压患儿的临床资料。其中，男35例，女19例；中位年龄5岁(0.8～...

Experience of vascular complications after Meso-rex bypass for portal hypertension

Objective To explore the causes and preventions of postoperative vascular complications of Rex shunt using internal jugular vein as a bypass vessel.Methods Retrospective analysis was performed for clinical data of patients with prehepatic portal hypertension from October 2014 to August 2019.Fifty-four patients were included with internal jugular vein(IJV)as a bypass vessel.Clinical features,ultrasonic findings,laboratory tests and gastroscopic observations were examined.Results No postoperative gastrointestinal bleeding was detected in children without vascular complications.Hypersplenism became alleviated or disappeared.Platelet count(PLT)rose significantly than those preoperatively(108.49±100.98&171.54±92.22,P<0.01)while splenic diameter(133.93±32.91&111.89±35.21,P<0.01)and splenic thickness(44.88±11.03&34.72±9.04,P<0.01)decreased.There were vascular complications(n=7,13.0%),vascular embolization(n=2,3.7%)and anastomotic stenosis(n=5,9.3%).Two patients with postoperative vascular embolization showed no relief of hypersplenism and gastrointestinal bleeding.After a second Rex shunt,postoperative vessels remained patent.Patients with anastomotic stenosis presented with persistent hyperhypersplenism and splenomegaly or gastrointestinal bleeding.Ultrasound and CT revealed anastomotic diameter<3 mm and blood flow rate increased 3-4 folds.Balloon vasodilation was successful in 2 patients with stenosis and stent implantation was performed for one child with a poor efficacy after dilatation.Vessels were unobstructed and the symptoms relieved while the remaining 2 patients were non-treated.Conclusions The operation of internal jugular vein bypass Rex had excellent outcomes with a high success rate.Vascular occlusion and anastomotic stenosis are the most important factors affecting postoperative outcomes or leading to surgical failure.Patients with vascular occlusion require reoperation and anastomotic stenosis may respond well to dilatation.