iPV-LPV术及CV-LPV术治疗小儿肝外门静脉高压症的前瞻性研究

摘要/Abstract

摘要： 目的前瞻性分析移植门静脉系统血管间置、门静脉主干-门静脉左支分流术(iPV-LPV)及胃冠状静脉-门静脉左支分流术(CV-LPV)治疗小儿肝外门静脉高压症的临床疗效。方法选取2016年3月—2021年3月遂宁市中心医院收治的64例肝外门静脉高压症患儿,入院后依据治疗方式不同分为iPV-LPV组(n=31)与CV-LPV组(n=33)。均在术后比较两组患儿围术期相关指标(手术时间、术中出血量、术后首次进食时间、术后首次下床时间和住院时间),于两组入院及术后6周时检查并比较肝动脉血流量、门静脉血流量、脾脏长度、脾脏厚度及血小板计数(PLT)和血红蛋白(Hb)水平,最后统计并比较两组住院期间并发症发生情况。结果 iPV-LPV组手术时间、术中出血量、术后首次进食时间、术后首次下床时间和住院时间分别为(176.9±47.5)min、(54.2±12.8)mL、(27.5±4.1)h、(2.4±0.5)d和(8.1±1.7)d,CV-LPV组分别为(210.4±50.4)min、(59.7±15.7)mL、(27.4±4.0)h、(2.8±0.9)d和(9.8±2.4)d;iPV-LPV组手术时间、术后首次下床时间及住院时间显著短于CV-LPV组(P<0.05);两组术中出血量和术后首次进食时间差异无统计学意义(P>0.05)。iPV-LPV组术前肝动脉血流量、门静脉血流量、脾脏长度和脾脏厚度分别为(375.4±72.4)mL/min、(1421.4±304.5)mL/min、(13.5±2.7)cm和(4.5±0.9)cm,术后分别为(514.7±94.8)mL/min、(1104.1±124.8)mL/min、(10.6±2.0)cm和(2.9±0.5)cm,CV-LPV组术前肝动脉血流量、门静脉血流量、脾脏长度和脾脏厚度分别为(375.6±72.7)mL/min、(1422.0±304.9)mL/min、(13.4±2.7)cm和(4.4±0.9)cm,术后分别为(439.8±84.1)mL/min、(1280.4±235.7)mL/min、(11.8±2.3)cm和(3.5±0.7)cm;iPV-LPV组术后肝动脉血流量显著高于CV-LPV组术后,而门静脉血流量、脾脏长度和脾脏厚度显著低于CV-LPV组术后(P<0.05);两组术后肝动脉血流量显著高于术前,而门静脉血流量、脾脏长度和脾脏厚度显著少于术前(P<0.05)。iPV-LPV组术前PLT和Hb水平分别为(159.1±42.4)×10⁹和(92.4±23.4)g/L,术后分别为(224.7±70.6)×10⁹和(105.4±26.4)g/L,CV-LPV组术前PLT和Hb水平分别为(159.3±42.5)×10⁹和(92.5±23.5)g/L,术后分别为(189.4±67.8)×10⁹和(105.6±26.4)g/L;iPV-LPV组术后PLT水平显著高于CV-LPV组术后(P<0.05);两组术后PLT和Hb水平显著高于术前(P<0.05)。iPV-LPV组术后并发症总发生率16.1%与CV-LPV组的18.2%比较差异无统计学意义(P>0.05)。结论与CV-LPV相比,iPV-LPV治疗小儿肝外门静脉高压症能够更好改善肝动脉血流量、门静脉血流量、脾脏长度、脾脏厚度及血清PLT水平,更有利于患儿术后恢复。

关键词: 肝外门静脉高压, 小儿, 肠-门分流术, 肝动脉, 门静脉, 脾脏

Abstract: Objective To prospectively analyze the clinical efficacy of main portal vein-left portal vein shunt with interposition of portal vessels (iPV-LPV) and gastric coronary vein-left portal vein shunt (CV-LPV) in the treatment of extrahepatic portal hypertension in children.Methods 64 children with extrahepatic portal hypertension admitted to our hospital from March 2016 to 2021 were selected. After admission, they were divided into iPV-LPV group (n=31) and CV-LPV group (n=33) according to different treatment methods. We compared perioperative related indicators of two groups after surgery, including operation time, intraoperative blood loss, first postoperative eating time, first postoperative getting out of bed time and hospitalization time. The hepatic venous blood flow, portal vein blood flow, spleen length spleen thickness, and blood platelet (PLT) count and hemoglobin (Hb) were examined and compared between the two groups at admission and 6 weeks after operation. Finally, the complications during hospitalization were counted and compared between the two groups.Results In the iPV-LPV group, the operation time, intraoperative blood loss, first postoperative eating time, first postoperative getting out of bed time and hospitalization time were (176.9±47.5) min, (54.2±12.8) mL, (27.5±4.1) h, (2.4±0.5) d, (8.1±1.7) d, those in CV-LPV group were (210.4±50.4) min, (59.7±15.7) mL, (27.4±4.0) h, (2.8±0.9) d, (9.8±2.4) d. The operation time, first postoperative getting out of bed time and hospitalization time in the iPV-LPV group were significantly shorter than those in the CV-LPV group (P＜0.05). There was no significant difference between the two groups in intraoperative blood loss and first postoperative eating time (P>0.05). The preoperative hepatic artery blood flow, portal vein blood flow, spleen length, and spleen thickness in the iPV-LPV group were (375.4±72.4) mL/min, (1421.4±304.5) mL/min, (13.5±2.7) cm, (4.5±0.9) cm, and those postoperatively were (514.7±94.8) mL/min, (1104.1±124.8) mL/min, (10.6±2.0) cm, (2.9±0.5) cm. The preoperative hepatic artery blood flow, portal vein blood flow, spleen length, and spleen thickness in the CV-LPV group were (375.6±72.7) mL/min, (1422.0±304.9) mL/min, (13.4±2.7) cm, and (4.4±0.9) cm, respectively, which were (439.8±84.1) mL/min, (1280.4±235.7) mL/min, (11.8±2.3) cm, (3.5±0.7) cm postoperatively. The postoperative hepatic artery blood flow in the iPV-LPV group was significantly higher than that in the CV-LPV group, while the portal vein blood flow, spleen length, and spleen thickness were significantly lower than those in the CV-LPV group after surgery (P＜0.05). The postoperative hepatic artery blood flow in the two groups was significantly higher than that before the operation, while the portal vein blood flow, spleen length, and spleen thickness were significantly less than those before the operation (P<0.05). The preoperative PLT and Hb levels in the iPV-LPV group were (159.1±42.4) × 10⁹ and (92.4±23.4) g/L, respectively, and the postoperative PLT and Hb levels were (224.7±70.6) × 10⁹ and (105.4±26.4) g/L, respectively. The levels of PLT and Hb before operation in the CV-LPV group were (159.3±42.5) × 10⁹ and (92.5±23.5) g/L, respectively, and after operation there were (189.4±67.8) × 10⁹ and (105.6±26.4) g/L, respectively. The postoperative PLT level in the iPV-LPV group was significantly higher than that in the CV-LPV group (P＜0.05). The levels of PLT and Hb after operation in the two groups were significantly higher than those before operation (P<0.05). There was no significant difference in the total incidence of postoperative complications in the iPV-LPV group and CV-LPV group (16.1% vs 18.2%, P>0.05).Conclusion Compared with CV-LPV, IPV-LPV in the treatment of children with extrahepatic portal hypertension can better improve the hepatic venous blood flow, portal venous blood flow, spleen length, spleen thickness and serum PLT, which is more conducive to postoperative recovery of children.

Key words: Extrahepatic portal hypertension, Children, Entero-portal shunt, Hepatic artery, Portal vein, Spleen

彭秋, 高海燕, 陈志力, 杜勇, 邹兵. iPV-LPV术及CV-LPV术治疗小儿肝外门静脉高压症的前瞻性研究[J]. 肝脏, 2022, 27(7): 803-806.

PENG Qiu, GAO Hai-yan, CHEN Zhi-li, DU Yong, ZOU Bing. Prospective study of iPV-LPV and CV-LPV in the treatment of extrahepatic portal hypertension in children[J]. Chinese Hepatolgy, 2022, 27(7): 803-806.

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