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目的评估门静脉左支血管转流术治疗小儿门静脉海绵样变性的疗效。方法对比15例门静脉海绵样变性患儿术前与术后门静脉压力、门静脉左支血流速度、门静脉左支直径、血细胞计数及食管胃底静脉曲张程度,分析影响手术有效性的因素。结果 15例患儿术前经门静脉彩色多普勒、CT门静脉造影均证实门静脉海绵样变性。术中门静脉造影示肝内门静脉分支通畅,将肝外门静脉属支与门静脉左支或脐静脉吻合行转流术,术后门静脉压力明显降低(P<0.01)。术后1周复查,门静脉多普勒示13例转流血管通畅,2例堵塞,手术成功率86.7%。2例手术失败患儿术后肝脏病理显示:1例慢性活动性肝炎,1例肝炎合并肝硬化。术后(33.3±10.9)个月,2例手术失败患儿经抗凝、抗血小板治疗转流血管均未再通,余13例转流血管通畅性良好。术后门静脉左支血流速度及直径明显增加(P<0.01);血细胞计数明显升高(P<0.05);食管胃底静脉曲张程度明显减轻(P<0.01)。肝脏病理、年龄均对手术有效性呈显著性影响(P<0.05)。结论门静脉左支血管转流术治疗门静脉海绵样变性疗效显著,因其较搭桥术操作简单、手术创伤小、术后患儿恢复快等优点,可成为治疗小儿门静脉海绵样变性的首选术式,且推荐在早期、肝脏无病变时施行手术
Objective To evaluate the curative effect of left portal vein bypass on cavernous degeneration of portal vein in children. Methods Preoperative and postoperative portal pressure, left portal vein branch velocity, left portal vein branch diameter, blood cell count and esophageal varices were analyzed in 15 children with portal degeneration of cavernous degeneration. The factors influencing operative effectiveness were analyzed. Results 15 cases of children with preoperative portal vein color Doppler, CT portography confirmed portal vein cavernous degeneration. Intraoperative portal venous angiography showed intrahepatic portal vein patency, the extrahepatic portal vein branch and portal vein left branch or umbilical vein anastomosis bypass surgery, postoperative portal pressure was significantly reduced (P <0.01). One week after the operation, portal vein Doppler showed 13 cases of open vessel patency, 2 cases of occlusion, the success rate of 86.7%. Two cases of surgical failure of children with postoperative liver pathology showed: 1 case of chronic active hepatitis, 1 case of hepatitis with cirrhosis. After operation (33.3 ± 10.9) months, no vascular bypass was achieved in 2 cases of surgical failure after anticoagulation and antiplatelet therapy, and the remaining 13 cases had good vascular patency. The velocity and diameter of the left branch of portal vein were significantly increased (P <0.01), the number of blood cells was significantly increased (P <0.05), and the degree of esophageal varices was significantly reduced (P <0.01). Liver pathology and age had significant effects on the operative effectiveness (P <0.05). Conclusions The treatment of portal cavernous degeneration with left branch of portal vein is effective in treating portal cavernous degeneration. Because of its advantages such as simple operation, less operation trauma and rapid postoperative recovery, it can become the first choice for treating cavernous degeneration of portal vein in children, And recommended in the early stage, the liver without surgery when surgery