论文部分内容阅读
目的 探讨胃冠状静脉-门静脉左支分流术治疗小儿肝外门静脉高压的效果和预后.方法 2008年10月至2013年1月,17例患儿因“呕血、黑便”等上消化道出血症状就诊.男9例,女8例;平均年龄4.9岁.完善腹部B型超声、增强CT和血常规检查.B型超声和CT检查均提示门静脉海绵样变、脾大和脾功能亢进,以“肝外门静脉高压”收入院.所有患儿均采用胃冠状静脉-门静脉左支分流术治疗肝外门静脉高压.2例患儿冠状静脉长度为2.5cm,分别移植4 cm和6.5cm肠系膜下静脉作为延长血管.所有患儿术后随访,随访时间为3～34个月(平均12个月).随访期间,采用超声检查评估脾脏大小和分流血管通畅情况.记录血常规和血生化检查结果.结果 所有患儿成功采用胃冠状静脉-门静脉左支分流术治疗.手术时间195～375 min,平均250 min.3例患儿术中输入1个单位同型红细胞,其余患儿未输血.住院时间9～22 d,平均15d.术后门静脉造影显示所有患几分流血管通畅.术后患儿血常规及血生化结果正常,随访超声显示分流血管通畅,脾脏明显缩小.2例患儿复发,保守治疗有效.结论 胃冠状静脉门静脉左支分流术是治疗小儿肝外门静脉高压的有效方法.“,”Objective To explore the effectiveness and prognosis of gastro-portal shunt for extra-hepatic portal hypertension in children.Methods The mean operative age of 17 patients (9 boys,8 girls) with portal hypertension was 4.9 years.Gastro-portal shunt was performed.Left gastric vein was mobilized and anastomosed to left portal vein.In 2 patients,left gastric vein had an inadequate length and required a graft of inferior mesenteric vein.The mean follow-up period was 12 (3-34)months.Results Gastro-portal shunt was successfully performed.The mean operative duration was 250 (195-375) min.Three patients underwent transfusion and the mean length of hospital stay was 15 (9-22) days.Intraoperative portal venous angiography demonstrated the patency of shunt in all patients.Postoperatively,complete blood count normalized and biochemical tests were within normal range.Postoperative ultrasound confirmed shunt patency and satisfactory flow of gastro-portal shunt in each patient.The size of spleen decreased.Two patients suffered from a recurrence of variceal bleeding and underwent conservative treatment.Conclusions Gastro-portal shunt is an effective treatment of extra-hepatic portal hypertension.