Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
Am J Surg. 2022 Jul;224(1 Pt B):530-534. doi: 10.1016/j.amjsurg.2022.01.031. Epub 2022 Feb 9.
Surgical shunts are commonly used to manage complications resulting from extrahepatic portal vein thrombosis (EHPVT) in children. We describe a single-center experience utilizing a functional Side-to-Side Splenorenal Shunt (fSRS), created using either an enlarged inferior mesenteric vein (IMV) or left adrenal vein (LAV).
Pediatric patients with isolated EHPVT who were poor candidates for a Rex shunt and who underwent a fSRS procedure at our institution between 2003 and 2020 were reviewed. The pre/post shunt portosystemic gradient change, rates of early and late complications, postoperative shunt patency, and mortality were evaluated.
Twelve EHPVT patients (mean age of 6.1 years) underwent a fSRS procedure. The mean portosystemic gradient change for the cohort was -11.7 mmHg (±4.9). There were no cases of recurrent variceal bleeding or episodes of shunt thrombosis reported after fSRS procedures.
Surgical shunts continue to be an important adjunct in the treatment of complications related to EHPVT. The functional Side-to-Side Splenorenal Shunt is a safe alternative that is easy to perform, involves minimal dissection and requires only a single anastomosis.
外科分流术常用于治疗儿童肝外门静脉血栓形成（EHPVT）引起的并发症。我们介绍了一种利用功能性侧侧门腔分流术（fSRS）的单中心经验，该手术使用扩大的肠系膜下静脉（IMV）或左肾上腺静脉（LAV）来创建。
回顾了 2003 年至 2020 年间在我院因 Rex 分流术不适合且接受 fSRS 手术的孤立性 EHPVT 患儿。评估了分流术前/后的门脉系统梯度变化、早期和晚期并发症发生率、术后分流术通畅率和死亡率。
12 例 EHPVT 患儿（平均年龄 6.1 岁）接受了 fSRS 手术。该组的平均门脉系统梯度变化为-11.7mmHg（±4.9）。fSRS 手术后，无复发性食管静脉曲张出血或分流术血栓形成的病例报告。
外科分流术仍然是治疗 EHPVT 相关并发症的重要辅助手段。功能性侧侧门腔分流术是一种安全的替代方法，操作简单，解剖损伤小，仅需进行一次吻合。
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