摘要
门静脉海绵样变性(cavernous transformation of the portal vein,CTPV)是儿童肝前性门静脉高压的主要病因,临床表现为呕血、黑便等一系列门静脉高压症候群。CTPV不仅影响儿童生长发育,出血严重时甚至可危及生命,因此提倡早诊断、早治疗。目前手术是治疗CTPV的主要方法,手术方式包括:断流术、分流术、肠系膜上静脉-肝内门静脉左支搭桥术(Rex手术)、联合手术及肝移植等,其中Rex手术由于可重建入肝血流,恢复儿童门静脉解剖结构和生理功能,是一种根治性治疗方法,已成为治疗儿童CTPV的主要手术方式。本文对断流术、选择性分流术、Rex手术等各种手术方式的国内外研究进展、手术疗效做一综述,并对Rex手术进行重点阐述。期望通过本综述可对CTPV患者的外科手术治疗有一个系统认识,为今后合理选择治疗方案提供参考依据。
Cavernous transformation of the portal vein(CTPV)is a major cause of prehepatic portal hypertension in children.It may cause a series of portal hypertension syndromes such as hematemesis and melena.It not only affects children's growth and development,but also endangers their lives in severe cases.Thus early diagnosis and treatment are recommended.At present,surgery is a major treatment for CTPV.The operative approaches include disconnection,shunting,superior mesenteric vein-left portal vein bypass(Rex operation)and operation plus liver transplantation,et al.Rex shunt is curative for CTPV due to its conformity with the physiological shunt of children.We conducted to review the latest domestic and international researches and related outcomes of various surgical approaches.And Rex operation is highlighted.This review is expected to provide a systematic understanding and reasonable selection of surgical approaches for pediatric CTPV.
作者
孙蕊(综述)
李龙(审校)
Sun Rui;Li Long(Department of General Surgery,Capital Institute of Pediatrics,Beijing 100020,China;Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100000,China)
出处
《临床小儿外科杂志》
CAS
2020年第12期1145-1151,共7页
Journal of Clinical Pediatric Surgery
基金
北京市医院管理局儿科学科协同发展中心儿科专项重点项目(编号:XTZD20180302)
北京协和医学院2019年“中央高校基本科研业务费”立项项目(编号:3332019166)。
