关键词: 小儿肝外门静脉高压, 门静脉左支分流术, 血流量, 肝动脉, 并发症

Abstract: Objective To investigate the therapeutic value of different left portal shunts in children with extrahepatic portal hypertension(EPH). Methods A total of 60 children with EPH admitted to our hospital from February 2013 to February 2018 were selected and divided into group A(n=32) and group B(n=28) according to the operation method. Group A underwent main portal vein-left portal vein shunt with interposition of portal vessels(iPV-LPV), and group B underwent gastric coronary vein-left portal vein shunt(CV-LPV). The perioperative indexes of the 2 groups were collected and analyzed. The blood flows of hepatic artery and portal vein were measured before operation, 2 and 6 weeks after operation. The levels of serum protein S, protein C and antithrombin III were measured before and 6 weeks after operation. And the incidence of complications was recorded. Results The operation time, time to first activity out of bed after operation and time of postoperative hospitalization in group A were significantly shorter than those in group B(174.32±43.65 vs. 207.15±53.76 min, 46.24±5.19 vs. 49.25±6.42 h, 8.64±1.15 vs. 9.42±1.38 d, P<0.05).The hepatic artery blood flows at week 2 and 6 after operation in group A were higher than those in group B(524.31±68.27 vs. 458.82±71.38 ml/min, 536.57±73.15 vs. 462.43±79.61 ml/min, P<0.05), while the portal vein blood flows were lower(1108.32±116.25 vs. 1221.63±107.04 ml/min, 1115.31±109.75 vs. 1208.18±105.42 ml/min, P<0.05). Serum protein S and C levels in group A were(2.48±0.13) μg/mL and(5.12±0.63) μg/mL at week 6 after operation, respectively, higher than those in group B, which were(2.36±0.17) μg/mL and(4.68±0.59) ug/ml(P<0.05). The incidences of complications were 6.25% in group A, which was not statistically significant compared with 14.28% in group B(P>0.05). Conclusion Compared with CV-LPV, iPV-LPV has higher surgical safety, which is able to promote the recovery of physical function in children after operation, to further improve the blood flows of hepatic artery and portal vein, and to up-regulate the levels of serum protein S and protein C.

Key words: Extrahepatic portal hypertension in children, Left portal shunt, Blood flow, Hepatic artery, Complication