Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Eur J Gastroenterol Hepatol. 2012 Oct;24(10):1219-26. doi: 10.1097/MEG.0b013e3283567ca3.
This was a prospective observational study carried out to objectively assess the effect of shunt surgery on intestinal morphology and function in patients with extrahepatic portal vein obstruction (EHPVO) and correlate it with growth improvement.
Twenty patients who were operated upon for EHPVO were divided into two groups for the purpose of analysis depending on the outcome of surgery: group A--patients who underwent successful shunt surgery (n=14) and group B--patients who underwent splenectomy with devascularization (n=1) and those with thrombosed shunts (n=5). The patient groups were created on the basis of the type and outcome of the surgery and not prospective stratification. Growth parameters, endoscopy findings, duodenal histology, brush border enzyme activity, urinary D-xylose levels, fecal steatocrit, fecal α-1 antitrypsin, serum growth hormone and insulin-like growth factor-1 levels, and quality-of-life scores were assessed before surgery and at a mean of 24.9 weeks after surgery.
There was no significant difference between the preoperative and postoperative duodenal histology. Preoperative brush border lactase activity was significantly lower than normal and did not change significantly after surgery. EHPVO did not affect intestinal absorption or permeability. Shunt surgery resulted in significantly improved z scores for height after surgery as well as quality of life. There was no significant growth hormone resistance.
Our patients did not have any significant malabsorption or abnormality in small intestinal structure and function when compared with established normal levels. There was no significant change in the above parameters after shunt surgery, although an improvement in growth was observed. Thus, factors other than enteropathy or other lesser known enteral factors seem to be responsible for the growth retardation observed in EHPVO and its subsequent improvement after shunt surgery.
本前瞻性观察研究旨在客观评估门腔静脉分流术对肝外门静脉高压症（EHPVO）患者肠形态和功能的影响，并将其与生长改善相关联。
对 20 例 EHPVO 患者进行手术治疗，并根据手术结果将其分为两组进行分析：A 组——接受成功分流术的患者（n=14）和 B 组——接受脾切除术伴断流术的患者（n=1）和分流术血栓形成的患者（n=5）。患者分组是基于手术的类型和结果，而不是前瞻性分层。在手术前和手术后平均 24.9 周评估生长参数、内镜检查结果、十二指肠组织学、刷状缘酶活性、尿 D-木糖水平、粪便脂类、粪便α-1 抗胰蛋白酶、血清生长激素和胰岛素样生长因子-1 水平以及生活质量评分。
术前和术后十二指肠组织学无显著差异。术前刷状缘乳糖酶活性明显低于正常水平，术后无明显变化。EHPVO 不影响肠道吸收或通透性。分流术可显著改善术后身高 z 评分和生活质量。无明显生长激素抵抗。
与既定的正常水平相比，我们的患者在小肠结构和功能方面没有明显的吸收不良或异常。分流术后上述参数没有明显变化，但观察到生长改善。因此，除了肠病或其他未知的肠内因素外，其他因素似乎是导致 EHPVO 生长迟缓及其随后分流术后改善的原因。
