Hu Tingze, Feng Jiexiong, Liu Wenying
Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2004 Jul;18(4):281-4.
To evaluate the effect of triplex operations (splenopneumopexy, portal azygous devascularization and ligation of splenic artery) for children with extrahepatic portal hypertension.
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).
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.
The triplex operation is an effective procedure for the control of hemorrhage from varices in children with extrahepatic portal hypertension.
评估三联手术（脾肺固定术、门静脉奇静脉断流术及脾动脉结扎术）治疗肝外门静脉高压症患儿的效果。
1993年3月至1998年11月，7例肝外门静脉高压症患儿接受了三联手术。这些患者的诊断通过胃镜、钡餐及多普勒超声检查得以确诊。术前及术后检查白细胞和血小板数量以及肝功能。在脾动脉结扎前后检查自由门静脉压力。所有患者随访2至8年（平均5.6年）。记录上消化道出血发作情况。通过钡餐和胃镜评估食管远端和胃近端静脉曲张程度。通过B超测量脾静脉和门静脉直径。采用彩色多普勒血流成像评估门静脉肺分流和门静脉血流。通过粘度计（北京R-20 Seerle）获取诸如红细胞压积、全血和血浆粘度等血液流变学指标以及红细胞变形性和聚集性指标。
该组无手术死亡病例。术后，食管和胃静脉曲张出血得到完全控制。尽管脾脏直径逐渐缩小，但随访期间无患者脾脏恢复至正常大小。静脉曲张程度减轻，自由门静脉压力从术前的（42.62±6.72）cmH₂O显著降至（34.48±5.71）cmH₂O（P<0.05）。门静脉血流速率也降低。门静脉血流方向为双向（一部分背离肝脏，另一部分朝向肝脏）。术后白细胞和血小板数量以及全血粘度和红细胞压积升至正常水平。
三联手术是控制肝外门静脉高压症患儿静脉曲张出血的有效方法。
