联合手术治疗儿童门静脉海绵样变性肝前性门静脉高压症

目的评估联合手术治疗儿童门静脉海绵样变性引起的肝前性门静脉高压症的疗效。方法2例门静脉海绵样变性和反复上消化道出血的患儿行脾切除脾肾静脉分流加贲门周围血管离断术;1例因断流术后再出血,行肠系膜上-腔静脉分流加贲门周围血管离断术,分析这3例的临床疗效。结果手术并发症和手术死亡率为0,随访13~31个月,肝功能正常,贫血纠正。无再出血、门静脉高压性胃病和肝性脑病。结论联合手术,特别是脾切除脾肾静脉分流加贲门周围血管离断术,安全、有效,适用于各种血流动力学状态,应成为治疗儿童门静脉海绵样变性引起的肝前性门静脉高压症的首选术式。

THE EFFECT OF COMBINED OPERATION ON PREHEPATIC PORTAL HYPERTENSION CAUSED BY CAVERNOMATOUS TRANSFORMATION OF PORTAL VEIN IN CHILDHOOD

Objective To evaluate the effects of combined operation on prehepatic portal hypertension(PHT)caused by cavernomatous transformation of portal vein(CTPV)in childhood.Methods Of 3 child patients with recurrent upper gastrointestinal bleeding,2 received splenectomy and splenorenal shunt combined with pericardial devascularization,the other one who had recurrence of bleeding after devasclarization,received mesocaval shunt combined with pericardial devascularization.The consequence of procedures was analyzed.Result The incidences of operative complication and mortality were 0.During follow up period,hepatic function was kept in normal range and anemia was cured.No recurrent hemorrhage,portal hypertensive gastropathy and hepatic encephalopathy were observed.Conclusion The combined operation,especially splenectomy and splenorenal shunt combined with pericardial devascularization,is a safe and effective surgical intervension which can be adapt to all hemodynamic disturbance caused by PHT,and should be the best surgical choice for prehepatic PHT caused by CTPV in childhood.