Renard T H, Andrews W S, Rollins N, Zwiener R J, Andersen J, Shimaoka S, McClelland R N
Department of Surgery, University of Texas Southwestern Medical Center at Dallas.
J Pediatr Surg. 1994 Mar;29(3):403-6. doi: 10.1016/0022-3468(94)90579-7.
Variceal bleeding remains a common cause of morbidity for children with both intrahepatic and extrahepatic portal hypertension. Occasionally, patients referred for liver transplant evaluation have significant variceal bleeding, despite adequate synthetic liver function. During a 7-year period, 322 children were referred for liver transplant evaluation. Six underwent distal splenorenal shunt surgery after evaluation. There were four boys and two girls. The average age was 11 +/- 4 years, and the average weight was 39 +/- 15 kg. The etiology of variceal bleeding was intrahepatic portal hypertension in five (1 biliary atresia, 2 chronic hepatitis, 2 congenital hepatic fibrosis) and extrahepatic portal vein thrombosis in one. Two patients had no previous attempts at sclerotherapy (one because of an abnormality in platelet function, the other because of extensive gastric varices), and four had multiple previous sclerotherapy treatments. No patient had preoperative encephalopathy. Three cases were Child's class A, and three were Child's class B. Preoperative evaluation of the portasystemic system was performed with magnetic resonance (MR) imaging or splenoportography. All patients underwent a distal splenorenal shunt procedure, four of whom also had splenopancreatic disconnection. One patient required 100 mL of blood replacement, and five required no blood. The average length of hospital stay was 9.8 +/- 2.2 days. Postoperative complications were minimal. All patients are alive, without recurrent gastrointestinal bleeding or encephalopathy, and they have patent shunts, which was confirmed by MR or Doppler ultrasound at a mean of 25 +/- 20 months after shunt surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
静脉曲张出血仍然是肝内和肝外门静脉高压患儿发病的常见原因。偶尔，尽管肝功能合成足够，但转诊进行肝移植评估的患者仍有严重的静脉曲张出血。在7年期间，322名儿童被转诊进行肝移植评估。6名患者在评估后接受了远端脾肾分流手术。其中有4名男孩和2名女孩。平均年龄为11±4岁，平均体重为39±15千克。静脉曲张出血的病因是肝内门静脉高压5例（1例胆管闭锁、2例慢性肝炎、2例先天性肝纤维化），肝外门静脉血栓形成1例。2例患者以前未尝试过硬化治疗（1例因血小板功能异常，另1例因广泛的胃静脉曲张），4例患者以前接受过多次硬化治疗。没有患者术前有脑病。3例为Child A级，3例为Child B级。采用磁共振成像（MR）或脾门静脉造影对门体系统进行术前评估。所有患者均接受了远端脾肾分流手术，其中4例还进行了脾胰断离术。1例患者需要输注100毫升血液，5例患者不需要输血。平均住院时间为9.8±2.2天。术后并发症极少。所有患者均存活，无复发性胃肠道出血或脑病，分流均通畅，分流手术后平均25±20个月通过MR或多普勒超声证实。（摘要截短至250字）
