中国105例肝外门静脉阻塞患儿行雷克斯分流术的中长期疗效
Medium-to Long-term Outcomes of Rex Shunt in 105 Children With Extrahepatic Portal Vein Obstruction in China.
作者信息
Wang Jieqin, Ning Yu, Ren Huifang, Hong Miao, You Fuyu, Bai Xiaoling, Chang Xiaopan, Liang Qifeng, Liang Jiankun, Wen Zhe
机构信息
Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China.
Clinical Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China.
出版信息
J Pediatr Surg. 2025 Feb;60(2):161930. doi: 10.1016/j.jpedsurg.2024.161930. Epub 2024 Sep 14.
PURPOSE
The aim of our study was to analyze the medium-to long-term outcomes of Rex shunts in a large series of children with extrahepatic portal vein obstruction (EHPVO).
METHODS
The clinical data of 105 children aged between 6 months and 16 years with EHPVO who underwent Rex shunt between October 2014 and June 2021 at our center were retrospectively reviewed after more than 2 years of follow-up.
RESULTS
The overall patency rate of the Rex shunt was 91.43% (96/105) during a median follow-up of 41 months (range, 24-98 months). Eighty-seven (82.86%) of the 105 patients underwent classical Rex shunt with internal jugular vein (IJV) bypass, and the remaining 18 patients (17.14%) underwent modified Rex shunt with intra-abdominal vein bypass. Patients with a patent shunt experienced portal hypertension resolution, which was characterized by a reduction in portal pressure, disappearance of variceal bleeding, relief of gastroesophageal varices, and relief of splenomegaly or hypersplenism. The rate of Rex shunt thrombosis in our center was 8.57% (9/105), and a repeat Rex shunt was effective for the treatment of graft thrombosis. Anastomotic stenosis occurred in 14.26% (15/105) of the children, 38.46% (5/13) of whom received successful endovascular intervention therapy and experienced remission of portal hypertension symptoms. The patency rate of the classical Rex shunt was higher than that of the modified Rex shunt (97.70% vs. 61.11%), whereas the rate of vascular complications, including anastomotic stenosis and graft thrombosis, of the classical Rex shunt was lower than that of the modified Rex shunt (11.49% vs. 77.78%). Further comparison revealed that the risk of vascular complications was substantially greater in the modified Rex shunt group than in the classical Rex shunt group in the nonadjusted model, minimally adjusted model, and fully adjusted model (RR ranged from 6.77 to 7.07, all p < 0.001).
CONCLUSIONS
The Rex shunt provides medium-to long-term benefits for children with EHPVO. The classical Rex shunt with IJV bypass provides the best patency rate and the fewest vascular complications.
LEVELS OF EVIDENCE
Ⅲ TYPE OF STUDY: Retrospective comparative study.
目的
本研究旨在分析大量肝外门静脉阻塞（EHPVO）患儿行雷克斯分流术的中长期疗效。
方法
回顾性分析2014年10月至2021年6月在本中心接受雷克斯分流术的105例6个月至16岁EHPVO患儿的临床资料，随访时间超过2年。
结果
在中位随访41个月（范围24 - 98个月）期间，雷克斯分流术的总体通畅率为91.43%（96/105）。105例患者中，87例（82.86%）接受了经典的经颈内静脉（IJV）搭桥雷克斯分流术，其余18例患者（17.14%）接受了经腹内静脉搭桥改良雷克斯分流术。分流术通畅的患者门静脉高压得到缓解，表现为门静脉压力降低、静脉曲张出血消失、胃食管静脉曲张减轻以及脾肿大或脾功能亢进缓解。本中心雷克斯分流术血栓形成率为8.57%（9/105），重复雷克斯分流术对移植血管血栓形成有效。14.26%（15/105）的患儿发生吻合口狭窄，其中38.46%（5/13）接受了成功的血管内介入治疗，门静脉高压症状缓解。经典雷克斯分流术的通畅率高于改良雷克斯分流术（97.70%对61.11%），而经典雷克斯分流术的血管并发症发生率，包括吻合口狭窄和移植血管血栓形成，低于改良雷克斯分流术（11.49%对77.78%）。进一步比较显示，在未调整模型、最小调整模型和完全调整模型中，改良雷克斯分流术组的血管并发症风险显著高于经典雷克斯分流术组（RR范围为6.77至7.07，均p < 0.001）。
结论
雷克斯分流术为EHPVO患儿提供了中长期益处。经典的经IJV搭桥雷克斯分流术通畅率最高，血管并发症最少。
证据级别
Ⅲ 研究类型：回顾性比较研究。
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