肝外门静脉阻塞患儿的生长发育障碍通过肠系膜-左门静脉分流术得到改善。

Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass.

机构信息

Department of Surgery, Children's Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA.

出版信息

J Pediatr Surg. 2009 Nov;44(11):2067-70. doi: 10.1016/j.jpedsurg.2009.05.016.

DOI:10.1016/j.jpedsurg.2009.05.016

PMID:19944209

Abstract

BACKGROUND

Extrahepatic portal vein obstruction (EHPVO) has been associated with growth impairment in children. We hypothesized that growth parameters improve after reversal of portal hypertension and restoration of mesenteric venous blood flow to the liver by the mesenterico-left portal vein bypass (MLPVB).

METHODS

A retrospective review of 45 children with idiopathic EHPVO who underwent MLPVB between 1997 and 2007 and had follow-up data for analysis was carried out. Growth was assessed using SD scores (z scores) for height, weight, and body mass index (BMI) at the time of operation and at early (5-12 months) and late (13-24 months) follow-up.

RESULTS

The mean height and weight of children with EHPVO was significantly lower than the general population before surgery. Mean BMI was also lower, although statistically insignificant. All parameters increased significantly after MLPVB as follows: height from -0.42 before surgery to -0.12 (P = .027) at 5 to 12 months and -0.14 (P = .026) at 13 to 24 months; weight from -0.49 before surgery to 0.03 (P < .001) at 5 to 12 months and 0.35 (P < .001) at 13 to 24 months; and BMI from -0.22 before surgery to 0.17 (P = .001) at 5 to 12 months and 0.48 (P < .001) at 13 to 24 months.

CONCLUSION

Restoration of portal blood flow to the liver by MLPVB improves growth in children with EHPVO.

摘要

背景

肝外门静脉阻塞（EHPVO）与儿童生长发育受损有关。我们假设通过肠系膜-左门静脉旁路（MLPVB）逆转门脉高压并恢复肠系膜静脉血流向肝脏后，生长参数会得到改善。

方法

对 1997 年至 2007 年间接受 MLPVB 治疗且有随访数据进行分析的 45 例特发性 EHPVO 患儿进行回顾性研究。在手术时以及早期（5-12 个月）和晚期（13-24 个月）随访时，使用身高、体重和体重指数（BMI）的标准差（z 评分）评估生长情况。

结果

EHPVO 患儿的身高和体重平均值明显低于手术前的一般人群。平均 BMI 也较低，但无统计学意义。所有参数在 MLPVB 后均显著增加，具体如下：身高从术前的-0.42 增加到术后 5-12 个月的-0.12（P=0.027）和 13-24 个月的-0.14（P=0.026）；体重从术前的-0.49 增加到术后 5-12 个月的 0.03（P＜0.001）和 13-24 个月的 0.35（P＜0.001）；BMI 从术前的-0.22 增加到术后 5-12 个月的 0.17（P=0.001）和 13-24 个月的 0.48（P＜0.001）。