Moon Suk-Bae, Jung Sung-Eun, Ha Jong-Won, Park Kwi-Won, Seo Jeong-Kee, Kim Woo-Ki
Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea.
World J Surg. 2008 Mar;32(3):483-7. doi: 10.1007/s00268-007-9356-0.
In the current era of transplantation and therapeutic endoscopy, the role of the distal splenorenal shunt (DSRS) for portal hypertension (PH) has diminished. We reviewed the outcome of the use of DSRS in children to determine the usefulness of this operation.
In the follow-up course for PH from 1987 to 2006, 15 patients who developed severe thrombocytopenia (platelet count <50 x 10(3)/mm(3)) and/or leukopenia (WBC count <3000/mm(3)) with normal liver function were referred for DSRS. Primary diagnosis was portal vein thrombosis (N=10) and congenital hepatic fibrosis (N=5). Platelet, WBC count, liver function test, and spleen size were checked before and after DSRS. Shunt patency was accessed postoperatively. Operative morbidity, mortality, and long-term outcomes were measured.
Platelet count and WBC count increased in individual patients. Mean value of each count increased significantly after DSRS (p=0.002, .004, respectively). Spleen size decreased significantly (N=7, p=0.018). Shunt patency rate was 100%. There was one postoperative complication and no postoperative mortality. Two patients developed portopulmonary hypertension. No patients underwent subsequent transplantation or endoscopic treatment for gastroesophageal varices after DSRS.
DSRS is an effective and reliable procedure for children with PH and is still useful for selected pediatric patients.
在当前移植和治疗性内镜检查的时代，远端脾肾分流术（DSRS）在门静脉高压症（PH）中的作用已减弱。我们回顾了儿童使用DSRS的结果，以确定该手术的有效性。
在1987年至2006年对PH的随访过程中，15例肝功能正常但出现严重血小板减少（血小板计数<50×10³/mm³）和/或白细胞减少（白细胞计数<3000/mm³）的患者被转诊接受DSRS。主要诊断为门静脉血栓形成（n = 10）和先天性肝纤维化（n = 5）。在DSRS前后检查血小板、白细胞计数、肝功能测试和脾脏大小。术后评估分流的通畅情况。测量手术发病率、死亡率和长期结果。
个别患者的血小板计数和白细胞计数增加。DSRS后每项计数的平均值显著增加（分别为p = 0.002，0.004）。脾脏大小显著减小（n = 7，p = 0.018）。分流通畅率为100%。有1例术后并发症，无术后死亡。2例患者出现门肺高压。DSRS后，没有患者因食管胃静脉曲张接受后续移植或内镜治疗。
DSRS是治疗儿童PH的一种有效且可靠的手术，对特定的儿科患者仍然有用。
