Department of General Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
Department of General Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
J Vasc Surg Venous Lymphat Disord. 2018 Nov;6(6):742-747. doi: 10.1016/j.jvsv.2018.01.020. Epub 2018 May 22.
Patency of the bypass vein after a Rex shunt is an important indicator of prognosis. However, there is no report about the change of caliber of the bypass vein after a Rex shunt. The aim of this study was to identify postoperative changes of the bypass vein and to assess the relationship with prognosis.
Between October 2008 and October 2016 in our center, 114 children were diagnosed with extrahepatic portal venous obstruction. The portal cavernoma-portal bypass with interposition of grafted portal vessels was performed in 31 children, the gastroportal shunt was performed in 54 children, and other Rex shunts were performed in another 29 children. At follow-up, the patency and diameter of the bypass vein were assessed with ultrasound and computed tomography. The intraoperative and postoperative diameters of the bypass vein were compared to identify postoperative changes of the bypass vein. Prognosis was compared between children with and children without an enlarged bypass vein.
The caliber of the bypass vein was enlarged in 50% of children (40/80) at 6 months postoperatively. The postoperative incidences of rebleeding and esophageal varices were significantly lower in children with an enlarged bypass vein than in those without (P < .05). Postoperatively, the reduced splenic size was significantly higher in children with an enlarged bypass vein than in those without (P < .05). The postoperative increase in platelet count in children with an enlarged bypass vein was significantly higher than in those without (P = .006). There was no significant difference in the flow velocity of the bypass vein between children with and children without an enlarged bypass vein (P = .133). The portal pressure was significantly reduced after surgery in children with an enlarged bypass vein than in children without an enlarged bypass vein (P = .017).
The caliber of the bypass vein increases in 50% of children after a Rex shunt using a grafted portal vessel, which is related to a better prognosis.
Rex 分流术后旁路静脉通畅是预后的重要指标。然而，目前尚无关于 Rex 分流术后旁路静脉口径变化的报道。本研究旨在探讨术后旁路静脉的变化，并评估其与预后的关系。
2008 年 10 月至 2016 年 10 月，我院共收治 114 例肝外门静脉高压患儿。31 例行门静脉海绵窦-门静脉旁路带蒂门静脉移植术，54 例行胃-门静脉分流术，29 例行其他 Rex 分流术。随访时，采用超声和 CT 评估旁路静脉的通畅性和直径。比较术中与术后旁路静脉直径，观察术后旁路静脉变化。比较旁路静脉增粗与不增粗患儿的预后。
术后 6 个月，旁路静脉增粗患儿占 50%（40/80）。旁路静脉增粗患儿再出血和食管静脉曲张的发生率明显低于不增粗患儿（P<0.05）。旁路静脉增粗患儿脾脏缩小程度明显高于不增粗患儿（P<0.05）。旁路静脉增粗患儿术后血小板计数升高幅度明显高于不增粗患儿（P=0.006）。旁路静脉增粗与不增粗患儿旁路静脉血流速度无明显差异（P=0.133）。旁路静脉增粗患儿术后门静脉压力明显低于不增粗患儿（P=0.017）。
使用带蒂门静脉移植术行 Rex 分流术后，旁路静脉增粗患儿占 50%，旁路静脉增粗与较好的预后相关。
