Goel P, Srivastava K, Das N, Bhatnagar V
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi - 110 029, India.
J Indian Assoc Pediatr Surg. 2010 Oct;15(4):117-21. doi: 10.4103/0971-9261.72433.
Nitric oxide (NO) in peripheral venous blood has been shown to be elevated in experimental portal hypertension. This study aims to determine the serum NO levels in patients with extrahepatic portal venous hypertension (EHPVO) pre- and postoperatively and to analyze whether these can serve as a reliable and early indicator of shunt blockage or malfunction.
During the period 2006-2010, 48 children with EHPVO were included in this prospective study; 40 underwent porto-systemic shunt and eight underwent splenectomy with devascularization. NO was evaluated preoperatively, 14 days after surgery, at 3 months and then 6 monthly thereafter. The median follow-up duration was 21 months. Shunt patency was confirmed with Doppler and computed tomography portography. Forty-eight age-matched children with hypospadias served as controls.
NO was higher in EHPVO patients as compared with controls (43.16 ± 16.27 vs. 5.76 ± 2.62 μmol/l) (P = 0.0001). There was a significant decline in the NO levels (4.64 ± 3.18 μmol/l) following shunt surgery (P = 0.0001), and it continued to remain low till the shunt was patent. A shunt block was indicated by rising NO levels in all five patients. The devascularization group also demonstrated a significant decline in the NO levels (27.06 ± 3.56 μmol/l) (P = 0.002), but it was less as compared with the shunted patients. The decline in the portal pressure after shunt surgery was found to correlate with the decline in the serum NO levels.
The blood levels of NO can be used in the diagnosis of portal hypertension, and are useful for monitoring the patency of the shunt.
实验性门静脉高压症患者外周静脉血中的一氧化氮（NO）水平已被证实升高。本研究旨在测定肝外门静脉高压症（EHPVO）患者术前及术后的血清NO水平，并分析其是否可作为分流阻塞或功能障碍的可靠早期指标。
2006年至2010年期间，48例EHPVO患儿纳入本前瞻性研究；40例行门体分流术，8例行脾切除加去血管化手术。术前、术后14天、3个月及此后每6个月评估NO水平。中位随访时间为21个月。通过多普勒和计算机断层扫描门静脉造影确认分流通畅情况。48例年龄匹配的尿道下裂患儿作为对照。
与对照组相比，EHPVO患者的NO水平更高（43.16±16.27 vs. 5.76±2.62μmol/L）（P = 0.0001）。分流术后NO水平显著下降（4.64±3.18μmol/L）（P = 0.0001），且在分流保持通畅之前一直维持在较低水平。所有5例患者NO水平升高提示分流阻塞。去血管化组的NO水平也显著下降（27.06±3.56μmol/L）（P = 0.002），但与分流患者相比下降幅度较小。发现分流术后门静脉压力的下降与血清NO水平的下降相关。
NO的血水平可用于门静脉高压症的诊断，对监测分流的通畅情况有帮助。
