彩色多普勒超声评估儿童Abernethy畸形及术后并发症的价值

Value of color Doppler ultrasonography in evaluating Abernethy malformation and postoperative complications in children

目的分析儿童Abernethy畸形术前及术后彩色多普勒超声表现,探讨超声诊断Abernethy畸形及术后并发症的价值。方法回顾性分析2017年2月至2021年11月在首都儿科研究所附属儿童医院普外科接受手术治疗证实为Abernethy畸形的12例患儿的临床及超声资料。术前超声与分流血管结扎后术中门静脉X线造影进行比较,探讨术前超声诊断Abernethy畸形的准确性;术后超声与CT血管造影比较,总结分流血管结扎后血栓常见位置。结果术前超声9例患儿门静脉主干未显示或呈条索状,诊断为Abernethy畸形Ⅰ型可能;3例门静脉主干细窄诊断为Abernethy畸形Ⅱ型。术中阻断分流血管后门静脉X线造影,11例门静脉主干显影,证实为Abernethy畸形Ⅱ型;仅1例门静脉主干未显影,证实为Abernethy畸形Ⅰ型。术前超声诊断Abernethy畸形分型准确率33.3%。术前超声诊断分流血管位置:7例经粗大肠系膜下静脉汇入髂静脉,1例经粗大肠系膜下静脉汇入下腔静脉,2例脾静脉与肠系膜上静脉汇合后共干汇入下腔静脉,2例脾静脉与左肾静脉间交通。术中门静脉X线造影与术前超声诊断分流血管位置基本一致。同时术中可见肠系膜下静脉分流合并有结直肠表面迂曲扩张静脉网。术后超声观察分流血管结扎后均不同程度闭塞或血栓化。3例脾静脉胰腺后段继发血栓,其中1例阻塞门静脉主干继发门静脉海绵样变。上述血栓均经CT血管造影证实。结论①Abernethy畸形Ⅱ型门静脉主干纤细,术前超声检查易误诊为Abernethy畸形Ⅰ型;②术前超声可明确Abernethy畸形分流血管位置;③反复便血患儿应重点探测肠系膜下静脉-髂静脉/下腔静脉分流;④术后超声可早期发现门脉系统血栓,为临床抗凝治疗提供帮助。

Objective To analyze the preoperative and postoperative color Doppler ultrasonographic features of Abernethy malformation in children,and to investigate the value of ultrasound diagnosis of Abernethy malformation and postoperative complications.Methods A retrospective analysis was performed on the clinical and ultrasound data of twelve cases of Abernethy malformation confirmed by surgical treatment in the General Surgery Department of the Children′s Hospital Affiliated to Capital Institute of Pediatrics from February 2017 to November 2021.A comparison was made between preoperative ultrasound and intraoperative portal vein angiography after shunt ligation to explore the accuracy of preoperative ultrasound in diagnosing Abernethy malformation;The common location of thrombosis after shunt ligation was summarized by comparing postoperative ultrasound with CT angiography.Results Preoperative ultrasonography showed no main portal vein or cable shape in 9 cases,and they were diagnosed as probable Abernethy typeⅠ;The main portal vein was narrow in 3 cases,and they were diagnosed as Abernethy typeⅡ.The main portal veins of 11 case were developing and they were confirmed as Abernethy malformation typeⅡby portal vein angiography after blocking of portosystemic shunt;the main portal vein of 1 case was not developing which was confirmed as Abernethy typeⅠ.The classification accuracy of preoperative ultrasound diagnosis of Abernethy malformation was 33.3%.Preoperative ultrasound diagnosis of shunt vessel location:the coarse inferior mesenteric veins of 7 cases flowed into the iliac vein,the coarse inferior mesenteric vein of 1 case flowed into the inferior vena cava,splenic vein and superior mesenteric vein converged and flowed into inferior vena cava in 2 cases,splenic vein and left renal vein communicated in 2 cases.The location of shunt vessels diagnosed by portal vein X-ray angiography was basically consistent with preoperative ultrasonography.At the same time,inferior mesenteric vein shunt combined with tortuous and dilated vein network on colorectal surface was observed.After ligation of shunt vessels,all of shunt vessels were occluded or thrombolized in varying degrees.Splenic vein retropancreatic segment of three cases occured secondary thrombosis,and one case of blocked portal vein occured secondary cavernous change.All the thrombi were confirmed by CT angiography.Conclusions①The main portal vein of Abernethy malformation typeⅡis tenuous,and is easily misdiagnosed Abernethy malformation typeⅠby preoperative ultrasound examination;②Preoperative ultrasound can determine the location of Abernethy malformed shunt vessels;③The shunt between the inferior mesenteric vein-iliac vein/inferior vena cava should be emphatically explored in children with recurrent hematochezia;④Postoperative ultrasound can detect portal vein thrombosis early and provide help for clinical anticoagulant therapy.