Das Somak, Manadal Tuhin Subhra, Das Suman, Biswas Jayanta, Gupta Arunesh, Mukherjee Sreecheta, Ray Sukanta
Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, India.
Ann Hepatobiliary Pancreat Surg. 2023 Nov 30;27(4):350-365. doi: 10.14701/ahbps.23-025. Epub 2023 Jun 20.
BACKGROUNDS/AIMS: Extra hepatic portal venous obstruction (EHPVO) is the most common cause of portal hypertension in Indian children. While endoscopy is the primary modality of management, a subset of patients require surgery. This study aims to report the short- and long-term outcomes of EHPVO patients managed surgically.
All the patients with EHPVO who underwent surgery between August 2007 and December 2021 were retrospectively reviewed. Postoperative complications were classified after Clavien-Dindo. Binary logistic regression in Wald methodology was used to determine the predictive factors responsible for unfavourable outcome.
Total of 202 patients with EHPVO were operated. Mean age of patients was 20.30 ± 9.96 years, and duration of illness, 90.05 ± 75.13 months. Most common indication for surgery was portal biliopathy (n = 59, 29.2%), followed by bleeding (n = 50, 24.8%). Total of 166 patients (82.2%) had shunt procedure. Splenectomy with esophagogastric devascularization was the second most common surgery (n = 20, 9.9%). Nine major postoperative complications (Clavien-Dindo > 3) were observed in 8 patients (4.0%), including 1 (0.5%) operative death. After a median follow-up of 56 months (15-156 months), 166 patients (82.2%) had favourable outcome. In multivariate analysis, associated splenic artery aneurysm ( = 0.007), isolated gastric varices ( = 0.004), preoperative endoscopic retrograde cholangiography and stenting ( = 0.015), and shunt occlusion ( < 0.001) were independent predictors of unfavourable long-term outcome.
Surgery in EHPVO is safe, affords excellent short- and long-term outcome in patients with symptomatic EHPVO, and may be considered for secondary prophylaxis.
背景/目的：肝外门静脉阻塞（EHPVO）是印度儿童门静脉高压最常见的病因。虽然内镜检查是主要的治疗方式，但一部分患者需要手术治疗。本研究旨在报告接受手术治疗的EHPVO患者的短期和长期预后。
对2007年8月至2021年12月期间接受手术的所有EHPVO患者进行回顾性分析。术后并发症按照Clavien-Dindo分类。采用Wald方法进行二元逻辑回归分析，以确定导致不良预后的预测因素。
共有202例EHPVO患者接受了手术。患者的平均年龄为20.30±9.96岁，病程为90.05±75.13个月。最常见的手术指征是门静脉性肝病（n = 59，29.2%），其次是出血（n = 50，24.8%）。共有166例患者（82.2%）接受了分流手术。脾切除加食管胃去血管化是第二常见的手术（n = 20，9.9%）。8例患者（4.0%）出现9例主要术后并发症（Clavien-Dindo>3），包括1例（0.5%）手术死亡。中位随访56个月（15 - 156个月）后，166例患者（82.2%）预后良好。多因素分析显示，合并脾动脉瘤（P = 0.007）、孤立性胃静脉曲张（P = 0.004）、术前内镜逆行胆管造影及支架置入（P = 0.015）和分流闭塞（P < 0.001）是长期不良预后的独立预测因素。
EHPVO手术是安全的，对于有症状的EHPVO患者，能提供良好的短期和长期预后，可考虑用于二级预防。
