先天性肝外门腔静脉分流并下消化道出血的治疗

目的 总结先天性肝外门腔静脉分流导致便血的病例,探讨对其的诊断和治疗方法.方法 回顾分析自1990年至2010年7例先天性肝外门腔静脉异常分流并下消化道出血患儿的临床资料.,并随访其治疗效果.结果 通过B超、CT扫描和结肠镜检可以明确诊断便血是由于先天性肝外门腔静脉异常分流引起,并且判断异常血管浸润的界限和范围,术中结扎侵入结肠直肠的异常血管,随访2～10年,便血基本停止,未再出现贫血.结论 由于先天性肝外门腔静脉分流引起便血比较罕见,B超、CT和结肠镜对诊断其病因和病变范围有很好帮助,结扎肛门、直肠、结肠局部异常血管的结扎术是最简单、可行和可靠的治疗方法.

Treatment of lower gastrointestinal bleeding secondary to congenital extrahepatic portocaval shunts

Objective To summarize the operative experience of the surgical ligation the shunt of colon and anus for children with lower gastrointestinal bleeding secondary to congenital extrahepatic portocaval shunts(CEPS).Methods Seven patients with lower gastrointestinal bleeding caused by CEPS (Abernethy type 2)were analyzed retrospectively.The diagnostic imaging and medical records for the patients were retrieved and evaluated.Surgical ligation of the veins of colon and anus was performed in all these patients.All patients were followed up from 2 to 12 years.Results The diagnosis of CEPS was confirmed by Ultrasonography (US),CT scan and colonoscopy.The colonoscopy showed blood vascular densely covered in colon and anus.And the congenital mesenterico-caval shunt was noted in all these patients by US and CT.After surgical ligation of the veins of colon and anus,the patients recovered very well,no blood bleeding was noted during follow-up term.Conclusions Lower gastrointestinal bleeding can be caused by congenital extrahepatic portocaval shunts.Surgical ligation of the veins of colon and anus is a successful treatment of lower gastrointestinal bleeding secondary to CEPS.