[Triplex operations for children with extrahepatic portal hypertension].

OBJECTIVE

To evaluate the effect of triplex operations (splenopneumopexy, portal azygous devascularization and ligation of splenic artery) for children with extrahepatic portal hypertension.

METHODS

From March 1993 to November 1998, 7 children with extrahepatic portal hypertension underwent triplex operations. The diagnosis for these patients were confirmed by gastroscopy, barium meal and Doppler ultrasonography. The number of WBC and platelet and the hepatic function were checked before and after operations. And the free portal pressures were checked before and after ligations of the splenic artery. All patients were followed up for 2 to 8 years (5.6 years on average). The episodes of upper gastrointestinal bleeding were recorded. The degrees of varices of distal esophagus and proximal stomach were assessed by barium meal and gastroscopy. The diameters of the splenic and portal veins were obtained by B ultrasound. The portopulmonary shunt and portal blood flow were evaluated by color Doppler flow image. The indices of hemorheology such as hematocrit, viscosity of whole blood and plasma, and the index of deformability and aggregability of RBC were obtained through viscometer (R-20 Seerle, Beijing).

RESULTS

There was no operative fatal case in this group. Postoperatively, hemorrhage from the esophagus and gastric varices was completely controlled. Although the diameter of spleen reduced progressively, no patient's spleen recovered to normal size during the follow up period. The degree of varices was mitigated and the free portal pressure was significantly decreased to (34.48+/-5.71) cm H2O from the preoperative one (42.62+/-6.72) cm H2O (P<0.05). The rate of portal flow was also decreased. The direction of portal vein was bidirection (one part was away from the liver and the other was toward the liver). The number of WBC and platelet and the viscosity of whole blood and hematocrit were increased to normal value after operation.

CONCLUSION

The triplex operation is an effective procedure for the control of hemorrhage from varices in children with extrahepatic portal hypertension.