经皮曲张静脉栓塞术治疗门静脉高压食管胃静脉曲张出血高风险的患儿疗效分析

Clinical analysis of percutaneous variceal embolization in children with portal hypertension at high risk of esophagogastric variceal bleeding

目的分析经皮曲张静脉栓塞术(PTVE)治疗门静脉高压食管胃静脉曲张出血高风险的患儿疗效。方法回顾性分析2018年10月至2023年5月在重庆医科大学附属儿童医院行PTVE的14例门静脉高压患儿资料,所有患儿均诊断为食管胃静脉曲张出血高风险,其中男性9例,女性5例,年龄7个月~12岁10个月,中位年龄1岁11个月。门静脉高压病因分别为门静脉海绵样变5例,肝移植术后门静脉吻合口狭窄7例,失代偿期肝硬化2例。所有患儿均行PTVE,分析手术入路、术中测量的门静脉压力、并发症,随访预后、术后治疗、消化道出血情况。结果14例患儿术中测定门静脉压力为(21.3±4.1)mmHg(1 mmHg=0.133 kPa),门静脉压力范围为15.8~28.6 mmHg。14例患儿均顺利完成PTVE,经肝入路11例,经脾入路3例。所有患儿均无异位栓塞、穿刺道出血等并发症。5例门静脉海绵样变患儿中,4例于PTVE术后1~27个月行Meso-Rex术,剩余1例因患儿无Meso-Rex术指征,于PTVE术后11个月行肝移植术;7例肝移植术后门静脉吻合口狭窄患儿于栓塞同期行血管球囊扩张术;2例失代偿期肝硬化分别于栓塞术后3个月、7个月行肝移植术。所有患儿随访5~60个月,无死亡,2例消化道出血,其余12例均未发生术后消化道出血。结论PTVE是门静脉高压食管胃静脉曲张出血高风险患儿有效的微创防治手段,术后出血率低。

ObjectiveTo analyze the efficacy of percutaneous variceal embolization(PTVE)in children with portal hypertension at high risk of esophageal variceal bleeding.MethodsClinical data of 14 children undergoing PTVE in Children's Hospital Affiliated to Chongqing Medical University from October 2018 to May 2023 were retrospectively analyzed,including 9 males and 5 females,with a median age of 1 years and 11 months,ranging from 7 months to 12 years and 10 months.The causes of portal hypertension were portal vein spongiosis in 5 cases,portal vein anastomotic stenosis after liver transplantation in 7 cases and decompensated cirrhosis in 2 cases.PTVE was performed in all patients.The surgical approach,intraoperative portal vein pressure,complications,prognosis,and gastrointestinal bleeding were analyzed.ResultsThe portal vein pressure was(21.3±4.1)mmHg(1 mmHg=0.133 kPa),ranging from 15.8 to 28.6 mmHg.PTVE was successfully completed in all cases,with 11 cases by hepatic approach and 3 cases by splenic approach.All patients were embolized without puncture bleeding.Among the 5 cases with portal vein spongiosis,Meso-Rex was performed in 4 cases from 1 to 27 months after PTVE,and liver transplantation was performed in 1 case 11 months after PTVE for there was no indication of Meso-Rex.Balloon dilatation was performed during embolization in 7 patients with portal vein anastomotic stenosis after liver transplantation.Two cases of decompensated cirrhosis underwent liver transplantation at 3 months and 7 months after embolization,respectively.All children were followed up for 5 to 60 months,and no death occurred,two cases had gastrointestinal bleeding.ConclusionPTVE could be an effective minimally invasive treatment for children with portal hypertension at high risk of esophageal and gastric varices bleeding,and the incidence of posttreatment gastrointestinal bleeding rate is low.