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目的 探讨移植血管间置、门静脉主干-肝内门静脉左支分流术在治疗小儿肝外门静脉高压中的效果和预后.方法 回顾性分析2010年1月至2014年12月9例(男6例,女3例)因“呕血、黑便”等上消化道出血表现入院,入院后完善腹部CT、超声及门静脉血管B型超声检查,诊断为门静脉海绵样变、门静脉高压和脾大患儿的临床资料.所有患儿均行移植血管间置、门静脉主干-肝内门静脉左支分流术治疗,术中造影发现胃冠状静脉直径较细或长度不够,不能行胃冠状静脉-门静脉左支分流术治疗,遂采用移植自体血管的方式,将其两端分别与门静脉主干和肝内门静脉左支吻合.其中采用移植空肠静脉方法治疗2例,回肠静脉4例,肠系膜下静脉3例.患儿术后均获随访,随访时间1～60个月,平均24.6个月.随访期间,采用超声评估脾大小及分流血管通畅情况.记录血常规、血生化和血氨,评估脾功能亢进情况和肝功能.结果 所有患儿均成功行移植血管间置、门静脉主干-门静脉肝内左支分流术治疗.手术时间105～360 min,平均218.3 min.其中3例住院期间有输血记录.术后住院时间6～10d,平均7.2d.术后复查B型超声示脾长径为9.6～14.7 cm,厚径为3.4～5.4 cm;较术前(长径10.4～17.6 cm,厚径3.2～6.8 cm)明显降低.血常规、生化和血氨均恢复正常.随访B型超声可见分流血管通畅,血管直径为0.5～0.7 cm,平均0.6 cm;分流血管入肝血流速度为0.14～0.18 m/s,平均0.16 m/s.1例患儿复发,采用保守治疗有效.结论 移植血管间置、门静脉主干-门静脉肝内左支分流术是治疗小儿肝外门静脉高压的有效方式之一,在患儿不能采用胃冠状静脉-门静脉左支分流术治疗时可考虑采用该方法治疗.“,”Objective To explore the effectiveness and prognosis of extra-hepatic portal vein-left intrahepatic portal shunting with interposition of bypass vein for extra-hepatic portal hypertension in children.Methods The mean operative age of 9 patients with portal hypertension (6 boys,3 girls) was 6.4 years.Due to unsuitable left gastric vein,gastro-portal shunt was not performed in all patients.Therefore extra-hepatic portal vein-left intrahepatic portal shunting with interposition of bypass vein was performed.Jejunal (n =2),ileal (n =4) and inferior mesenteric (n =3) veins were used.Bypass vein was mobilized and inserted between extra-hepatic portal and intra-hepatic left portal veins.The median follow-up period was 24.6 (1-60) months.Results Extra-hepatic portal vein-left intrahepatic portal shunting with interposition of bypass vein was successfully performed.The median operative duration was 218.3 (105-360) min.Three patients received transfusion.And the median length of hospital stay was 7.2 (6-10) days.Postoperatively,complete blood count normalized and biochemistry tests stayed within normal ranges.Postoperative ultrasound confirmed shunt patency and satisfactory flow in all patients.The size of spleen decreased.One patient with recurrent variceal hemorrhage received conservative treatment.Conclusions Extra-hepatic portal vein-left intrahepatic portal shunting with interposition of bypass vein is effective for extra-hepatic portal hypertension.