| 摘要: |
| ［摘要］ 目的 结合文献探讨儿童先天性胆总管囊肿（CCC）术后并发门静脉海绵样变性（CTPV）患儿诊治经验。方法 回顾性分析湖南省儿童医院收治的2例CCC术后并发CTPV患儿的临床资料及术后随访情况，并对相关文献进行总结分析。结果 病例1，女，6岁9个月，4年余前于外院行CCC根治术。病例2，女，11岁7个月，10余年前外院行CCC根治术。2例患儿均因消化道出血急诊入院，入院诊断CTPV。2例患儿术中造影均提示门静脉主干闭塞，行“门静脉矢状部-门静脉主干分流术（MPV-LPV）”，术后门静脉压力均降至正常范围。术后随诊1年，搭桥血管通畅，无消化道出血等并发症。结合文献复习共纳入8例CCC术后并发CTPV，其中2例行MPV-LPV，3例行胃左静脉-门静脉左支分流术（LGV-LPV），2例行Roux-Y空肠肝支静脉-门静脉左支分流术（RYV-LPV），1例行经皮经肝血管成形术。术后随访，7例分流血管通畅，1例出现分流血管闭塞。结论 CTPV是CCC术后少见的并发症。行CCC根治术时应注意保护门静脉，降低损伤风险。一旦出现消化道出血、脾亢等症状，建议首选Rex手术以恢复门静脉入肝血流。 |
| 关键词: 儿童 先天性胆总管囊肿 门静脉海绵样变性 Rex手术 术后并发症 |
| DOI：10.3969/j.issn.1674-3806.2025.06.09 |
| 分类号:R 726.5 |
| 基金项目:湖南省自然科学基金项目（编号：2023JJ30329） |
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| Experience in diagnosis and treatment of intercurrent cavernous transformation of the portal vein after surgery for congenital choledochal cyst in children and literature review |
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LIAO Siqi1,2, YIN Qiang2, PENG Yuming2, JI Chunyi2, CHEN Lijian2, XIE Weixin2
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1.School of Pediatrics, University of South China, Hengyang 421000, China; 2.The First Department of General Surgery, Hunan Children′s Hospital, Changsha 410007, China
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| Abstract: |
| ［Abstract］ Objective To discuss the experience in diagnosis and treatment of intercurrent cavernous transformation of the portal vein(CTPV) after surgery for congenital choledochal cyst(CCC) in children combining literature review. Methods The clinical data and postoperative follow-up results of 2 children with intercurrent CTPV after surgery for CCC who were admitted to Hunan Children′s Hospital were retrospectively analyzed, and the relevant literature was summarized and analyzed. Results Case 1: female, 6 years and 9 months old,undergoing radical surgery for CCC in another hospital more than 4 years ago. Case 2: female, 11 years and 7 months old, undergoing radical surgery for CCC in another hospital more than 10 years ago. The two children were diagnosed with CTPV following an emergency admission due to gastrointestinal bleeding. Intraoperative angiography indicated occlusion of the main portal vein in the two children, and the “main protal vein-left portal vein shunt(MPV-LPV)” was performed on them. The portal vein pressure after the operation decreased to the normal range in the two children. The two children were followed up for one year after the operation. The bypass vessels were unobstructed and there were no complications such as gastrointestinal bleeding in them. A total of 8 patients with intercurrent CTPV after surgery for CCC were included in combination with literature review. Among them, 2 patients received MPV-LPV, 3 patients received left gastric vein-left portal vein bypass(LGV-LPV) procedure, 2 patients received Roux-Y jejunal vein-left portal vein bypass(RYV-LPV) procedure, and 1 patient received percutaneous transhepatic angioplasty. After postoperative follow-up, 7 patients had unobstructed shunt vessels, and 1 patient had shunt vessel occlusion. Conclusion CTPV is a rare complication after surgery for CCC. During the radical surgery for CCC, attention should be paid to protecting the portal vein to reduce the risk of injury. Once symptoms such as gastrointestinal bleeding and hypersplenism occur, it is recommended to choose Rex shunt as the first option to restore the blood flow from the portal vein to the liver. |
| Key words: Children Congenital choledochal cyst(CCC) Cavernous transformation of the portal vein(CTPV) Rex shunt Postoperative complications |
