Wu Huiying, Zhou Ning, Lu Lianwei, Chen Xiwen, Liu Tao, Zhang Binbin, Liu Hongsheng, Wen Zhe
Department of Radiology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, Guangdong, China.
Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, Guangdong, China.
Insights Imaging. 2021 Jul 27;12(1):109. doi: 10.1186/s13244-021-01057-8.
Extrahepatic portal vein obstruction (EHPVO) is the most important cause of hematemesis in children. Intrahepatic left portal vein and superior mesenteric vein anastomosis, also known as meso-Rex bypass (MRB), is becoming the gold standard treatment for EHPVO. We analyzed the value of preoperative computed tomography (CT) in determining whether MRB is feasible in children with EHPVO.
We retrieved data on 76 children with EHPVO (50 male, 26 female; median age, 5.9 years) who underwent MRB (n = 68) or the Warren procedure (n = 8) from 2013 to 2019 and retrospectively analyzed their clinical and CT characteristics. The Rex recess was categorized into four subtypes (types 1-4) depending on its diameter in CT images. Of all 76 children, 7.9% had a history of umbilical catheterization and 1.3% had leukemia. Sixteen patients (20 lesions) had associated malformations. A total of 72.4% of Rex recesses could be measured by CT, and their mean diameter was 3.5 ± 1.8 mm (range 0.6-10.5 mm). A type 1, 2, 3, and 4 Rex recess was present in 9.2%, 53.9%, 11.8%, and 25.0% of patients, respectively. MRB could be performed in patients with types 1, 2, and 3, but those with type 4 required further evaluation. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of CT were 100%, 83.8%, 42.1%, 100%, and 85.5%, respectively.
Among the four types of Rex recesses on CT angiography, types 1-3 allow for the performance of MRB.
肝外门静脉阻塞（EHPVO）是儿童呕血的最重要原因。肝内左门静脉与肠系膜上静脉吻合术，也称为肠系膜-雷克斯分流术（MRB），正成为EHPVO的金标准治疗方法。我们分析了术前计算机断层扫描（CT）在确定MRB对EHPVO患儿是否可行方面的价值。
我们检索了2013年至2019年接受MRB（n = 68）或沃伦手术（n = 8）的76例EHPVO患儿（50例男性，26例女性；中位年龄5.9岁）的数据，并回顾性分析了他们的临床和CT特征。根据CT图像中雷克斯隐窝的直径，将其分为四种亚型（1 - 4型）。在所有76例患儿中?，7.9%有脐静脉插管史，1.3%患有白血病。16例患者（20处病变）伴有畸形。共有72.4%的雷克斯隐窝可通过CT测量，其平均直径为3.5±1.8毫米（范围0.6 - 10.5毫米）。1、2、3和4型雷克斯隐窝分别出现在9.2%、53.9%、11.8%和25.0%的患者中。1、2和3型患者可进行MRB，但4型患者需要进一步评估。CT的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性分别为100%、83.8%、42.1%、100%和85.5%。
在CT血管造影的四种雷克斯隐窝类型中，1 - 3型允许进行MRB。
