小儿肝外门静脉阻塞的外科分流术：系统评价。
Surgical shunts for extrahepatic portal vein obstruction in pediatric patients: a systematic review.
机构信息
Department of Surgery, University of Southern California, 1510 San Pablo Street, Suite 200, Los Angeles, CA 90033, USA; Pediatric Liver Transplant Program, Children's Hospital of Los Angeles, 4650 Sunset Boulevard, MS #147, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA.
Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA.
出版信息
HPB (Oxford). 2021 May;23(5):656-665. doi: 10.1016/j.hpb.2020.11.1149. Epub 2020 Dec 30.
BACKGROUND
Extrahepatic portal vein obstruction (EHPVO) causes portal hypertension in noncirrhotic children. Among surgical treatments, it is unclear whether the meso-Rex shunt (MRS) or portosystemic shunt (PSS) offers lower post-operative morbidity and superior patency over time. Our objective was to evaluate long-term outcomes comparing MRS and PSS for pediatric patients with EHPVO.
METHODS
A systematic review was conducted of articles reporting children undergoing surgical shunts for EHPVO from 1/2000-2/2020. Of 87 articles screened, 22 were eligible for inclusion. The primary outcome was shunt thrombosis and secondary outcomes included non-operative complications, stenosis, and re-operation.
RESULTS
Eighteen of 22 studies were of good quality and four had fair quality. Of 461 patients included, 340 underwent MRS and 121 underwent PSS. MRS were associated with a higher rate of post-operative thrombosis when compared to PSS (14.1% vs 5.8%, p = 0.021). There were 40/340 MRS patients (11.8%) that required at least one re-operation for either shunt thrombosis or stenosis, versus 5/121 PSS patients (4.1%), p = 0.019.
CONCLUSION
Both MRS and PSS result in acceptable long-term patency rates, but the more technically demanding MRS is associated with higher post-shunt thrombosis, often requiring further operative intervention. This study suggests that PSS may offer advantages for pediatric patients with EHPVO.
背景
肝外门静脉阻塞（EHPVO）可导致非肝硬化儿童发生门静脉高压。在外科治疗中，尚不清楚间置肠系膜上腔静脉-门静脉分流术（MRS）与门体静脉分流术（PSS）哪种手术术后并发症更少，且随着时间的推移更通畅。我们的目的是评估 MRS 和 PSS 治疗 EHPVO 患儿的长期疗效。
方法
对 2000 年 1 月至 2020 年 2 月期间报道儿童 EHPVO 行手术分流术的文章进行了系统评价。在筛选出的 87 篇文章中，有 22 篇符合纳入标准。主要结局是分流术血栓形成，次要结局包括非手术并发症、狭窄和再次手术。
结果
22 项研究中有 18 项质量良好，4 项质量中等。共纳入 461 例患者，其中 340 例行 MRS，121 例行 PSS。与 PSS 相比，MRS 术后血栓形成的发生率更高（14.1% vs 5.8%，p = 0.021）。340 例行 MRS 的患者中有 40 例（11.8%）因分流术血栓形成或狭窄至少需要再次手术，而 121 例行 PSS 的患者中有 5 例（4.1%），p = 0.019。
结论
MRS 和 PSS 均可获得可接受的长期通畅率，但技术要求更高的 MRS 术后血栓形成发生率更高，常需进一步手术干预。本研究提示 PSS 可能对 EHPVO 患儿具有优势。
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