Bernard O, Alvarez F, Alagille D
Chir Pediatr. 1982 May-Jun;23(3):229-33.
The retrospective study of 115 children in whom a successful portosystemic shunt was carried out for portal hypertension, provides the following conclusions: 1) Patency of the shunt must be checked by esophageal endoscopy, six months postoperatively. A patent shunt can be expected when the size of the spleen and/or thrombocytopenia improve in the early post-operative period. Early ultrasound examination is also very useful in that respect. 2) None of the children with extrahepatic portal vein obstruction or congenital hepatic fibrosis presented with clinical signs of portal systemic encephalopathy (PSE). 3) Eight of 30 children with cirrhosis presented with one or more clinical episodes of PSE. Some were transient allowing for a normal diet to be resumed later on. 4) It is thus advisable to give children with cirrhosis a low protein diet in the months after surgery. Protein content of the diet can usually be increased progressively over a period of one to two years. 5) Whenever splenectomy is necessary, it is mandatory to prevent pneumococcal infections with the pneumococcal vaccine and daily treatment with oral penicillin.
对115例因门静脉高压而成功实施门体分流术的儿童进行的回顾性研究得出以下结论：1）术后六个月必须通过食管内镜检查分流术的通畅情况。如果术后早期脾脏大小和/或血小板减少症有所改善，则可预期分流术通畅。早期超声检查在这方面也非常有用。2）肝外门静脉阻塞或先天性肝纤维化的儿童均未出现门体性脑病（PSE）的临床症状。3）30例肝硬化儿童中有8例出现了一次或多次PSE临床发作。有些是短暂性的，随后可恢复正常饮食。4）因此，建议在术后数月给肝硬化儿童低蛋白饮食。通常可在一到两年的时间内逐渐增加饮食中的蛋白质含量。5）每当需要进行脾切除术时，必须用肺炎球菌疫苗预防肺炎球菌感染，并每日口服青霉素进行治疗。
