目的:目的:回顾性分析有症状的门静脉高压症患儿的Rex分流术,它对脾功能亢进消退和静脉曲张根除的影响,评估分流生存和调查危险因素,会导致分流功能障碍和血栓形成.
方法:材料和方法:24名儿童(16名男性,8名女性),门静脉高压症纳入研究。在2010年1月至2022年3月期间,所有手术均在单个中心内进行。随访期为6.75±1.19年。
结果:结果:诊断时的年龄为5.39±0.64岁。5(20.8%)有脐带导管。16例(66.7%)表现为出血发作是门静脉高压症的第一个征兆。9例(37.5%)患儿表现为重度脾功能亢进。Rex分流的年龄为7.5±0.7岁。7例(31.8%)发生Rex分流血栓形成。1次成功取栓和6次脾肾分流术。Kaplan-Meyer分析显示Rex分流存活0.670(95CI0.420-0.831)。Logistic回归模型显示血小板计数(p=0.0423)和血细胞减少(p=0.0272)是影响分流血栓形成的因素。随访组18例。1p/o年p<0.05时,脾脏体积回归显着,1p/o月时血小板显着增加(p<0.01),静脉曲张消退时间为1p/o年(p<0,001)。
结论:结论:研究组的Rex分流有效率为70.9%。,分流生存评估0.670(95CI0.420-0.831)。在随访组所有患者中,Rex分流术在预防出血方面均有效。术前血小板计数(p=0.0423)和血细胞减少(p=0.0272)是影响分流血栓形成的因素。这是在RS术前应考虑的,需要进行以下研究。
OBJECTIVE: The aim: To analyze retrospectively our experience of Rex shunt in children with symptomatic portal hypertension, its effect on hypersplenism regression and varices eradication, assess shunt survival and investigate risk factors, that could lead to shunt dysfunction and thrombosis.
METHODS: Materials and methods: 24 children (16 males, 8 females) ,with portal hypertension included into the study. All surgeries were performed within single center in a period from January 2010 to March 2022. Follow up period was 6.75±1.19 years.
RESULTS: Results: Age at diagnosis was 5.39±0.64 years. 5 (20.8%) had umbilical catheter in anamnesis. 16 (66.7%) manifested bleeding episodes as the first sign of portal hypertension. 9 (37.5%) of children manifested severe hypersplenism. Age at Rex shunting was 7.5±0.7 years. In 7 (31.8%) cases Rex shunt thrombosis occurred. 1 successful thrombectomy and 6 splenorenal shunting were performed. Kaplan-Meyer analysis showed Rex shunt survival 0.670 (95%CI 0.420-0.831). Logistic regression model indicated thrombocytes count (p=0.0423) and cytopenia (p=0.0272) as factors that could influence shunt thrombosis. Follow-up group included 18 patients. Spleen volume regression became significant by 1 p/o year p<0,05, thrombocytes significant increasement reached in 1 p/o months (p<0.01), varices involution was achieved by 1 p/o year (p<0,001).
CONCLUSIONS: Conclusions: Rex shunt effectiveness in study group was 70.9%., shunt survival assessed 0.670 (95%CI 0.420-0.831). Rex shunt was effective in bleeding prophylaxis in all patients of follow up group. Preoperative thrombocytes count (p=0.0423) and cytopenia (p=0.0272) were detected as factors that could influence shunt thrombosis, that is to be considered in RS preoperative period and require following studies.