小儿门静脉海绵样变性的外科治疗

Surgical Management of Cavernous Degeneration of Portal Vein in Children

目的探讨小儿门静脉海绵样变性的外科治疗方法。方法总结收治的16例小儿门静脉海绵样变性病例的临床表现、彩色多普勒的影像特征及手术中所见、实施手术的方法和效果。结果首发症状多为呕血、便血,少数表现为顽固性贫血,脾脏肿大是其重要体征熏均经彩色多普勒获得明确诊断。16例均行脾切除、贲门周围血管离断术有14例另加不同的分流手术。脾-肾分流手术适用于大多数门静脉海绵样变性的患儿,年龄及肾血管的直径不一定是限定手术的条件。术后随访显示患儿贫血纠正,上消化道出血明显改善。彩色多普勒显示分流处血流通畅。结论该病治疗以手术治疗为主,在脾切除、贲门周围血管离断术的基础上,分流术可以获得良好的效果。

Objective To discuss the experience for surgical management of cavernous degeneration of portal vein in children. Methods The clinical manifestations, color doppler ultrasonography image characters, surgical findings, surgical methods and results of 16 children with cavernous degeneration of portal vein were reviewed. Results Hematemesis and hemafecia were the first presentations. Some cases had pertinacious anaemia. Splenomegaly was the important sign .The diagnosis was confirmed by color doppler ultrasonography.16 cases underwent splenectomy and mutilation of cardiac peripheral veins. Fourteen of them had received different shunt way. Splenorenal shunt was applicable to the most children with cavernous degeneration of portal vein .Renal vein diameter and ages were not the certainly surgical qualifications. All received orperative children were followed up. Anaemia was rectified, the upper alimentary tract haemorrhage was improved obviously. Color doppler ultrasonography has demonstrated that the blood flow of shunt is normal. Conclusions Surgical operation is the major treatment. The splenorenal shunt may acquire the good effect in these patients who had underwent splenectomy and mutilation of cardiac peripheral vein.