"National Medical Research Center for Children's Health" Federal State Autonomous Institution of the Russian Federation Ministry of Health, Moscow, Russia.
Peoples Friendship University of Russia (RUDN University), Moscow, Russia.
J Laparoendosc Adv Surg Tech A. 2023 Dec;33(12):1231-1235. doi: 10.1089/lap.2022.0404. Epub 2023 Oct 16.
Portal hypertension is a syndrome characterized by increased pressure in the portal vein system and can be caused by impaired blood flow in the portal vein, hepatic veins, or inferior vena cava. The main complications of this condition are bleeding from varicose veins of the esophagus (in our study in 100% of patients), splenomegaly with hypersplenism (in our study in 98% of patients), ascites (in our study in 1 patient). The main goal of treating portal hypertension is to prevent bleeding from esophageal varices. However, today the goal of surgical treatment of portal hypertension in children is not only to prevent the development of bleeding but also the possible restoration of intrahepatic blood flow. A retrospective analysis of the results of treatment of portal hypertension in 75 children (41 boys, 34 girls) operated in our Center for the period from 2019 to 2022 was carried out. The mean age of the patients was 7 ± 1 years. Sixty-nine patients had an extrahepatic form of portal hypertension, and 6 patients had an intrahepatic form (liver fibrosis). In 14 patients (18.6%), the operation was repeated (a vascular shunt was previously applied in another hospital; 4 children were operated on repeatedly). A good result was obtained in all children, and the risk of bleeding from varicose veins of the esophagus was eliminated. Vascular bypass surgery was performed in all cases: mesoportal bypass in 17 (22.7%) patients, splenorenal bypass in 37 (49.3%) patients, mesocaval bypass in 21 (28%) patients. In 10 (13%) cases, repeated bypass surgery was required due to dysfunction or thrombosis of the previously performed bypass. In 14 (18.6%) patients with mesoportal shunts, blood flow in the liver was completely restored. The main method of surgical treatment of portal hypertension today is portosystemic bypass surgery, which effectively prevents bleeding from varicose veins of the esophagus. Mesoportal shunting is a definitive treatment for extrahepatic portal hypertension that restores portal perfusion of the liver.
门静脉高压症是一种以门静脉系统压力升高为特征的综合征，可由门静脉、肝静脉或下腔静脉血流受损引起。该病症的主要并发症是食管静脉曲张出血（在我们的研究中，100%的患者都有这种情况）、脾肿大伴脾功能亢进（在我们的研究中，98%的患者都有这种情况）、腹水（在我们的研究中，有 1 例患者有这种情况）。治疗门静脉高压症的主要目标是预防食管静脉曲张出血。然而，如今，儿童门静脉高压症的手术治疗目标不仅是预防出血的发生，而且是可能恢复肝内血流。我们对 2019 年至 2022 年期间在我们中心接受治疗的 75 例儿童（41 名男孩，34 名女孩）的门静脉高压症治疗结果进行了回顾性分析。患者的平均年龄为 7±1 岁。69 例患者为肝外型门静脉高压症，6 例患者为肝内型（肝纤维化）。14 例患者（18.6%）重复手术（此前在另一家医院进行了血管分流术；4 名儿童反复手术）。所有儿童均获得良好效果，消除了食管静脉曲张出血的风险。所有病例均行血管旁路手术：肠系膜上静脉-门静脉旁路术 17 例（22.7%），脾肾静脉旁路术 37 例（49.3%），肠系膜上静脉-下腔静脉旁路术 21 例（28%）。由于先前进行的旁路手术功能障碍或血栓形成，有 10 例（13%）需要再次旁路手术。在 14 例肠系膜静脉分流术患者中，肝脏血流完全恢复。目前，门静脉高压症的主要手术治疗方法是门体分流术，可有效预防食管静脉曲张出血。肠系膜静脉分流术是治疗肝外门静脉高压症的一种根治性方法，可恢复肝脏门静脉灌注。
