Lykavieris P, Gauthier F, Hadchouel P, Duche M, Bernard O
Service d'Hépatologie Pédiatrique, Service de Chirurgie, and Service de Radiologie, Département de Pédiatrie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
J Pediatr. 2000 Jun;136(6):805-8.
To estimate the risk of bleeding during adolescence and early adulthood in a group of children with portal vein obstruction who had not undergone an effective treatment beforehand.
Children (n = 44) were followed up from age 12 years to a mean age of 20 years (range, 15-34 years). Actuarial risk of bleeding, related to previous occurrence of gastrointestinal bleeding and to pattern of varices at age 12, was calculated yearly.
Twenty-four children presented with gastrointestinal bleeding after age 12, and 20 did not bleed. The overall actuarial probability of bleeding was 49% at age 16 and 76% at age 24. Probability of bleeding at age 23 was higher in children who had bled before age 12 than in children who had not bled (93% vs 56%; P =.007). Probabilities of bleeding at age 18 and at age 23 were 60% and 85%, respectively, in patients who had grade II or III esophageal varices at age 12. The 9 children without varices or with grade I varices only on endoscopy did not bleed between the ages of 12 and 20 years.
Children with portal vein obstruction have a >50% risk of bleeding during adolescence; the pattern of varices on endoscopy at age 12 may have a prognostic value.
评估一组预先未接受有效治疗的门静脉梗阻患儿在青春期及成年早期的出血风险。
对44名儿童进行随访，年龄从12岁至平均20岁（范围15 - 34岁）。每年计算与既往胃肠道出血发生情况及12岁时静脉曲张类型相关的出血精算风险。
24名儿童在12岁后出现胃肠道出血，20名未出血。16岁时出血的总体精算概率为49%，24岁时为76%。12岁前出血的儿童在23岁时的出血概率高于未出血的儿童（93%对56%；P = 0.007）。12岁时患有II级或III级食管静脉曲张的患者在18岁和23岁时的出血概率分别为60%和85%。9名在内镜检查中无静脉曲张或仅有I级静脉曲张的儿童在12至20岁之间未出血。
门静脉梗阻患儿在青春期有超过50%的出血风险；12岁时内镜检查的静脉曲张类型可能具有预后价值。
