Pediatric Surgery Department, Ain-Shams University, Cairo, Egypt.
Pediatric Surgery Department, Helwan University, Cairo, Egypt.
J Pediatr Surg. 2020 Oct;55(10):2238-2242. doi: 10.1016/j.jpedsurg.2020.06.016. Epub 2020 Jun 20.
To report our initial experience with splenectomy and proximal spleno-left portal shunt as an alternative to the standard Rex shunt, when not applicable, in children with Extrahepatic Portal Vein Obstruction (EHPVO).
Patients from March 2015 till September 2018, with EHPVO not suitable for Rex shunt or whose caregivers refused to consent for Internal Jugular Vein (IJV) dissection were assessed and prepared for splenectomy with proximal spleno-left portal shunt. The operative technique includes splenectomy, freeing of the splenic vein from the pancreatic bed till its junction with the inferior mesenteric vein, and then anastomosis with the intrahepatic left portal vein at the Rex recess. A distal lieno-renal shunt was performed in one patient and was excluded from the study.
A total of 14 patients (mean age: 4.6 years) underwent splenectomy with proximal spleno-left portal shunt during the study period. The mean operative time was 246 min, while the mean postoperative hospital stay was 4.1 days. The patients' follow up period ranged from 6 to 42 months (median: 19.6 months). Only two patients had a single attack of variceal bleeding, 2 and 2.5 months postoperative respectively, and required endoscopic management with no further bleeding episodes. While the rest of patients showed an improvement of their variceal grades after the surgery.
Splenectomy with proximal spleno-left portal shunt seems to be a valuable alternative to the standard Rex shunt in treatment of children with EHPVO unsuitable for or following unsuccessful Rex shunt.
IV.
报告我们在肝外门静脉阻塞（EHPVO）患者中，当不适合行标准 Rex 分流术或其家长拒绝行颈内静脉（IJV）切开术时，采用脾切除术加近端脾-门静脉分流术替代的初步经验。
2015 年 3 月至 2018 年 9 月期间，对不适合行 Rex 分流术或其家长拒绝行 IJV 切开术的 EHPVO 患者进行评估，并准备行脾切除术加近端脾-门静脉分流术。手术技术包括脾切除术、游离脾静脉，使其从胰腺床游离至与肠系膜下静脉汇合处，然后与肝内左门静脉在 Rex 隐窝处吻合。一名患者行远端脾肾分流术，该患者被排除在本研究之外。
共有 14 名患者（平均年龄：4.6 岁）在研究期间接受了脾切除术加近端脾-门静脉分流术。平均手术时间为 246 分钟，平均术后住院时间为 4.1 天。患者的随访时间为 6 至 42 个月（中位数：19.6 个月）。仅 2 名患者术后分别在 2 个月和 2.5 个月发生单次静脉曲张出血，需行内镜治疗，无再出血。而其余患者术后静脉曲张程度均有改善。
脾切除术加近端脾-门静脉分流术似乎是治疗不适合行标准 Rex 分流术或 Rex 分流术失败的 EHPVO 儿童的一种有价值的替代方法。
IV。
