González-Barba Isabel, Guillén Gabriela, Quintero Jesús, López Fernández Sergio, Pérez Lafuente Mercedes, Mercadal-Hally María Margaret, Padrós Cristina, Barnés Daniel, Martos Rodríguez Marta, Molino J Andrés
Pediatric Surgery Department, Pediatric Surgical Oncology, Neonatal and HBP Unit, Universitat Autónoma de Barcelona, Vall d'Hebron Barcelona Hospital Campus, Passeig de la Vall d´Hebron, 119-129, 08035, Barcelona, Spain.
Pediatric Hepatology and Liver Transplant Unit, Universitat Autónoma de Barcelona, Vall d´Hebron Barcelona Hospital Campus, Barcelona, Spain.
Pediatr Surg Int. 2025 Jul 12;41(1):207. doi: 10.1007/s00383-025-06114-7.
Meso-Rex procedure is the surgical treatment of choice for severe portal hypertension (PHT) secondary to extrahepatic portal vein obstruction (EHPVO). Our aim was to describe our initial experience using cryopreserved arterial allografts as an alternative shunting conduit.
Retrospective review of patients with EHPVO who underwent a Meso-Rex procedure using cryopreserved arterial allografts between January 2023 and April 2024.
Rex shunt surgery was performed in five of the eleven patients operated for EHPVO during this period. Arterial allografts were employed in four cases, with a mean age of 10 ± 1.2 years. The mean conduit diameter and length was 9.25 ± 3.5 and 73.5 ± 11.5 mm, respectively. With a mean follow-up of 16 ± 5 months, all patients developed shunt thrombosis secondary to calcification. Shunt flow was reestablished exclusively with percutaneous transhepatic thrombectomy and stenting in one patient. The remaining three patients required a revision surgery to remove the calcified graft: two Rex shunts were salvaged with polytetrafluoroethylene (PTFE) conduits and one was converted to a mesocaval shunt. All shunts are patent 6.5 ± 2.2 months after repermeabilization.
Although the intended use of cryopreserved arterial grafts was to avoid comorbidities associated with harvesting autologous conduits, they are not an alternative to the classic Meso-Rex procedure given the high thrombosis and reoperation rate secondary to shunt calcification.
Meso-Rex手术是治疗肝外门静脉阻塞（EHPVO）继发的严重门静脉高压（PHT）的首选手术方法。我们的目的是描述我们使用冷冻保存的动脉同种异体移植物作为替代分流管道的初步经验。
回顾性分析2023年1月至2024年4月期间接受使用冷冻保存的动脉同种异体移植物的Meso-Rex手术的EHPVO患者。
在此期间接受EHPVO手术的11名患者中有5名接受了Rex分流手术。4例使用了动脉同种异体移植物，平均年龄为10±1.2岁。导管平均直径和长度分别为9.25±3.5和73.5±11.5毫米。平均随访16±5个月，所有患者均因钙化继发分流血栓形成。仅1例患者通过经皮肝穿刺血栓切除术和支架置入术重新建立了分流血流。其余3例患者需要进行翻修手术以取出钙化的移植物：2例Rex分流术用聚四氟乙烯（PTFE）导管挽救，1例改为肠系膜上腔静脉分流术。所有分流在再通后6.5±2.2个月保持通畅。
尽管冷冻保存的动脉移植物的预期用途是避免与采集自体管道相关的合并症，但鉴于继发于分流钙化的高血栓形成率和再手术率，它们不能替代经典的Meso-Rex手术。
