颈内静脉搭桥Rex手术对肝外门静脉梗阻患儿抗凝血因子和门静脉压力的影响

Effect of internal jugular vein bypass Rex surgery on anticoagulant factors and portal pressure in children with extrahepatic portal vein obstruction

目的探讨采用颈内静脉搭桥的Rex手术(肠系膜上静脉-门静脉左支分流术)对肝外门静脉梗阻(extrahepatic portal vein obstruction,EHPVO)患儿抗凝血因子和门静脉压力的影响。方法回顾性分析2014年1月—2018年12月西安市儿童医院就诊的EHPVO患儿,所有患儿均接受Rex手术治疗。检测Rex手术前及术后1年时所有患儿的抗凝血因子,并检测血常规指标和门静脉压力相关指标,比较上述指标的前后差异。结果共纳入患儿32例,所有患儿于Rex手术后随访1年,无失访。术后1年时随访超声检查可见所有患儿门静脉血流均通畅,均无静脉血栓形成。患儿术后1年时的蛋白C、蛋白S浓度及抗凝血酶Ⅲ活性[(5.91±0.67)μg/mL、(2.43±0.34)μg/mL和(59.64±4.54)%]均较术前[(3.25±0.82)μg/mL、(2.02±0.37)μg/mL和(50.22±3.91)%]升高,差异均有统计学意义(P<0.05);抗凝血酶Ⅲ浓度与术前相比差异无统计学意义(P>0.05)。患儿术后1年时的红细胞计数、血红蛋白浓度、白细胞计数及血小板计数[(4.61±0.17)×10^(12)/L、(128.53±6.55)g/L、(6.09±0.72)×10^(9)/L和(104.88±5.74)×10^(9)/L]均较术前[(3.78±0.19)×10^(12)/L、(105.53±5.31)g/L、(3.39±0.58)×10^(9)/L和(87.42±5.53)×10^(9)/L]升高,差异均有统计学意义(P<0.05)。患儿术后1年时的门静脉左支直径较术前增大[(7.23±0.66)vs.(2.30±0.69)mm],脾脏体积较术前缩小[(55.74±4.07)vs.(67.21±4.22)cm^(3)],门静脉压力较术前降低[(23.37±1.27)vs.(35.29±1.36)cm H2O(1 cm H_(2)O=0.098 kPa)],差异均有统计学意义(P<0.05)。结论采用颈内静脉搭桥的Rex手术有利于改善EHPVO患儿抗凝血因子水平,改善门静脉血流情况及压力,并有效缓解脾功能亢进,有一定的推广价值。

Objective To investigate the effect of Rex surgery(superior mesenteric vein-left portal vein shunt)with internal jugular vein bypass on the anticoagulant factors and portal pressure in children with extrahepatic portal vein obstruction(EHPVO).Methods From January 2014 to December 2018,children with EHPVO in Xi’an Children’s Hospital were retrospectively analyzed.All children underwent Rex surgery.The anticoagulant factors,blood routine indicators,and portal pressure-related indicators of all children were tested before and 1 year after Rex surgery,and the differences were compared.Results A total of 32 children were enrolled,and all children were followed up for 1 year after Rex surgery,and no follow-up was lost.Follow-up ultrasound examination 1 year after surgery showed that the portal vein blood flow in all children was unobstructed,and there was no venous thrombosis.The concentration of protein C,protein S and antithrombinⅢactivity of the children 1 year after surgery[(5.91±0.67)μg/mL,(2.43±0.34)μg/mL and(59.64±4.54)%,respectively]were all higher than those before surgery[(3.25±0.82)μg/mL,(2.02±0.37)μg/mL and(50.22±3.91)%,respectively],and the differences were statistically significant(P<0.05).There was no statistically significant difference in the concentration of antithrombinⅢ1 year after surgery compared with that before surgery(P>0.05).The red blood cell count,hemoglobin concentration,white blood cell count and platelet count of the children1 year after surgery[(4.61±0.17)×10^(12)/L,(128.53±6.55)g/L,(6.09±0.72)×10^(9)/L and(104.88±5.74)×10^(9)/L,respectively]were all higher than those before surgery[(3.78±0.19)×10^(12)/L,(105.53±5.31)g/L,(3.39±0.58)×10^(9)/L and(87.42±5.53)×10^(9)/L,respectively],and the differences were statistically significant(P<0.05).The diameter of the left portal vein 1 year after surgery was larger than that before surgery[(7.23±0.66)vs.(2.30±0.69)mm],the spleen volume was smaller than that before surgery[(55.74±4.07)vs.(67.21±4.22)cm^(3)],and the portal vein pressure was lower than that before surgery[(23.37±1.27)vs.(35.29±1.36)cm H_(2)O(1 cm H2 O=0.098 kPa)],and the differences were statistically significant(P<0.05).Conclusion Rex surgery with internal jugular vein bypass is beneficial to improving the level of anticoagulant factors in children with EHPVO,improving portal vein blood flow and pressure,and effectively relieving hypersplenism,which has a certain promotion value.