Cwikiel W, Keussen I, Larsson L, Solvig J, Kullendorff C-M
Department of Radiology, University Hospital, Lund, Sweden.
Eur J Pediatr Surg. 2003 Oct;13(5):312-8. doi: 10.1055/s-2003-43571.
To present methods and results of interventional treatment of children with portal hypertension (PH) secondary to portal vein occlusion (PVO).
Five children, four boys and one girl, 8 - 14 years old, with symptomatic PH secondary to PVO were treated. All children had one or more episodes of bleeding from oesophageal varices, enlarged spleen and thrombocytopenia. Partial embolisation of the spleen was performed in four children. Attempts to recanalize the occluded part of the portal vein were done in all children using transjugular (n = 4), transhepatic (n = 4) and transsplenic (n = 3) approaches.
All procedures were carried out without serious complications and were followed by normalisation of the platelet count, decrease in splenic size and disappearance of bleeding. Recanalisation of the occluded portal vein with a stent was possible in one child and partial stent recanalisation was possible in another child. Transjugular intrahepatic portosystemic shunt (TIPS) with partly extrahepatic, intraperitoneal route was created in one patient. All children were scheduled for follow-up. During the observation time of 22 months (5 - 46 months), additional balloon dilation and placement of new stents were necessary in two children.
Interventional procedures are valuable in the treatment of children with symptoms secondary to PVO. Treatment should be customized and scheduled follow-ups of the patients are necessary.
介绍门静脉闭塞（PVO）继发门静脉高压（PH）患儿的介入治疗方法及结果。
对5例8至14岁有症状的PVO继发PH患儿进行治疗，其中4例男孩，1例女孩。所有患儿均有1次或多次食管静脉曲张出血、脾肿大和血小板减少。4例患儿进行了部分脾栓塞。所有患儿均采用经颈静脉（n = 4）、经肝（n = 4）和经脾（n = 3）途径尝试再通门静脉闭塞部分。
所有操作均未出现严重并发症，术后血小板计数恢复正常，脾肿大减轻，出血消失。1例患儿成功使用支架再通闭塞的门静脉，另1例患儿部分支架再通。1例患者创建了部分肝外、腹腔内途径的经颈静脉肝内门体分流术（TIPS）。所有患儿均安排了随访。在22个月（5至46个月）的观察期内，2例患儿需要额外进行球囊扩张和置入新支架。
介入治疗对PVO继发症状的患儿有重要价值。治疗应个体化，且对患者进行定期随访是必要的。
