Krebs-Schmitt D, Briem-Richter A, Grabhorn E, Burdelski M, Helmke K, Broering D C, Ganschow R
Department of Pediatric Gastroenterology, University Medical Center, Hamburg, Germany.
Pediatr Transplant. 2009 Aug;13(5):540-4. doi: 10.1111/j.1399-3046.2008.01109.x. Epub 2009 Feb 8.
Portal vein thrombosis can occur as a result of primary anomalies, after liver transplantation, and for other reasons. It may result in severe complications secondary to portal hypertension, such as bleeding from esophageal or gastric varices, hypersplenism, or impaired somatic growth. In this retrospective study, we analyzed the outcome of 25 children who underwent a Rex shunt procedure. The following venous grafts were used as the shunt: the autologous internal or external jugular vein (n = 17) or a cryopreserved graft (n = 5); in three patients the umbilical vein was recanalized. The median follow up time was 109 months (range 18 days-146 months). The best results were achieved in patients in whom an autologous jugular vein segment was used as a vascular graft for the Rex shunt (shunt patency of 88%). In patients with a functioning shunt no further lower or upper gastrointestinal bleeding occurred. And in the entire study population hypersplenism syndrome improved after surgery. In our large cohort of pediatric patients, the Rex shunt has shown to be an effective method to eliminate portal hypertension and to revascularize the liver and thereby prevents the possible consequences of long-term portosystemic shunting.
门静脉血栓形成可因原发性异常、肝移植后及其他原因而发生。它可能导致继发于门静脉高压的严重并发症，如食管或胃静脉曲张出血、脾功能亢进或身体生长发育受损。在这项回顾性研究中，我们分析了25例行雷克斯分流术儿童的治疗结果。以下静脉移植物用作分流：自体颈内或颈外静脉（n = 17）或冷冻保存移植物（n = 5）；3例患者的脐静脉再通。中位随访时间为109个月（范围18天至146个月）。使用自体颈静脉段作为雷克斯分流术的血管移植物的患者取得了最佳结果（分流通畅率为88%）。在分流功能良好的患者中，未再发生下消化道或上消化道出血。并且在整个研究人群中，脾功能亢进综合征术后有所改善。在我们的一大组儿科患者中，雷克斯分流术已被证明是一种消除门静脉高压和使肝脏血管再通的有效方法，从而预防了长期门体分流的可能后果。
