Prospective study of iPV-LPV and CV-LPV in the treatment of extrahepatic portal hypertension in children

Abstract

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

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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