Menon P, Rao K L N, Bhattacharya A, Thapa B R, Chowdhary S K, Mahajan J K, Samujh R
Department of Pediatric Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh, India.
Eur J Pediatr Surg. 2005 Apr;15(2):82-7. doi: 10.1055/s-2004-830341.
This study was carried out in order to determine whether children with extrahepatic portal hypertension show any improvement in growth parameters and quality of life after elective surgery.
All patients with extrahepatic portal hypertension who underwent surgery between April 1999 and March 2002 were studied prospectively. Height and weight before and after surgery were converted into Z scores for comparison. The quality of life was assessed by changes in scholastic ability, physical activity, social interaction, and economic effects on the family.
At the end of a minimum follow-up period of 1 year, of the 30 children, 50 % and 76 % showed improvement in weight and height Z scores, respectively, compared to their scores while on medical management. Z scores below - 2 SD for weight and height were seen in 57 % and 37 % of patients prior to surgery, and only in 40 % and 20 %, respectively at the end of follow-up, which ranged from 1 - 4 years. The improvement in height and weight was more in those who had undergone splenectomy with either devascularization or central splenorenal shunt compared to those who had undergone side-to-side lienorenal shunt without splenectomy. The children, who had dropped out of school while on medical management, either rejoined school or attended vocational courses after surgery. There was an improvement in school performance and physical activity in 85 % of the children. Improvement in personality was seen in 73 % of the affected patients. The cost incurred for surgery was one-third of the amount spent while on medical management.
Growth parameters improved significantly in children after surgical intervention for portal hypertension. Overall improvement in scholastic abilities, physical activity, and social interaction was noted in a majority of the patients. As a one-time procedure in a developing country, surgery is also more cost effective.
本研究旨在确定肝外门静脉高压症患儿在择期手术后生长参数和生活质量是否有所改善。
对1999年4月至2002年3月期间接受手术的所有肝外门静脉高压症患者进行前瞻性研究。将手术前后的身高和体重转换为Z评分进行比较。通过学业能力、身体活动、社交互动以及对家庭的经济影响的变化来评估生活质量。
在至少1年的随访期结束时，30名儿童中，与接受药物治疗时的评分相比，分别有50%和76%的儿童体重和身高Z评分有所改善。术前体重和身高Z评分低于-2标准差的患者分别为57%和37%，而在随访结束时（随访时间为1至4年），分别仅为40%和20%。与未行脾切除术的侧侧脾肾分流术患者相比，行脾切除术加去血管化或中央脾肾分流术的患者身高和体重改善更为明显。在接受药物治疗时辍学的儿童，术后要么重新上学，要么参加职业课程。85%的儿童学业成绩和身体活动有所改善。73%的受影响患者性格有所改善。手术费用仅为药物治疗费用的三分之一。
门静脉高压症患儿手术干预后生长参数显著改善。大多数患者在学业能力、身体活动和社交互动方面总体有所改善。作为发展中国家的一次性治疗手段，手术在成本效益方面也更高。
