de Ville de Goyet Jean, D'Ambrosio Giuseppe, Grimaldi Chiara
Department of Paediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, Rome, Italy.
Semin Pediatr Surg. 2012 Aug;21(3):219-32. doi: 10.1053/j.sempedsurg.2012.05.005.
The management of children with portal hypertension has dramatically changed during the past decade, with an improvement in outcome. This has been achieved by improved efficiency of endoscopic variceal control and the success of liver transplantation. Emergency surgical shunt procedures are rarely required, with acute bleeding episodes generally controlled endoscopically or, occasionally in adults, by interventional radiological procedures. Portosystemic shunts may be considered as a bridge to transplant in adults but are rarely used in this context in children. Nontransplant surgery or radiological interventions may still be indicated for noncirrhotic portal hypertension when the primary cause can be cured and to allow normalization of portal pressure before liver parenchyma is damaged by chronic secondary changes in some specific diseases. The meso-Rex bypass shunt is used widely but is limited to those with a favorable anatomy and can even be performed preemptively. Elective portosystemic shunt surgery is reserved for failure to respond to conservative management in the absence of alternative therapies.
在过去十年中，儿童门静脉高压症的管理发生了巨大变化，治疗结果有所改善。这得益于内镜下静脉曲张控制效率的提高以及肝移植的成功。急诊手术分流术很少需要，急性出血发作一般通过内镜控制，偶尔在成人中通过介入放射学方法控制。门体分流术可被视为成人肝移植的桥梁，但在儿童中很少用于这种情况。当原发性病因可以治愈且在某些特定疾病中肝脏实质尚未因慢性继发性改变而受损之前，非移植手术或放射学干预仍可用于非肝硬化性门静脉高压症，以使门静脉压力恢复正常。肠系膜上静脉-门静脉左支分流术应用广泛，但仅限于解剖结构有利的患者，甚至可以预防性进行。选择性门体分流手术仅用于在没有其他替代疗法的情况下对保守治疗无反应的患者。
