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首页> 外文期刊>Srpski Arhiv za Celokupno Lekarstvo >Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism
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Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism

机译：沃伦分流术结合部分脾切除术治疗小儿肝外门静脉高压，大量脾肿大和严重脾功能亢进

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Introduction. Extra-hepatic portal vein obstruction (EHPVO) is one of the most often causes of portal hypertension in children. Objective. Establishing the importance of shunt surgery in combination with partial spleen resection in selected pediatric patients with EHPVO, enormous splenomegaly and severe hypersplenism. Methods. Distal splenorenal shunt (DSRS) with partial spleen resection was performed in 22 children age from 2 to 17 years with EHPVO. Indications for surgery were pain and abdominal discomfort caused by spleen enlargement, as well as symptomatic hypersplenism with leucopenia, thrombocytopenia and anemia. The partial spleen resection was performed by ligation of blood vessels to caudal two thirds of the spleen. After ischemic parenchymal demarcation transection with electrocautery LigaSure was performed with preservation of 20-30% of spleen tissue, and then Warren DSRS was created. Platelet and leucocytes counts and liver function tests were obtained before, one month and one year after surgery. Growth was assessed with SD scores (Z scores) for height, weight and body mass index at the time of surgery and one year later. Results. In all patients postoperative period was without significant complications. Platelets and leucocytes counts were normalized. Patency rate of shunts was 100%. Two significant shunts stenosis were observed and successfully treated with percutaneous angioplasty. During the follow-up period (1 to 9 years) all patients were asymptomatic, with improved quality of life and growth. Conclusion. Results of our study indicate that shunt surgery with a partial spleen resection is an effective and safe procedure for patients with enormous splenomegaly and severe hypersplenism caused by EHPVO.
机译：介绍。肝外门静脉阻塞（EHPVO）是儿童门静脉高压的最常见原因之一。目的。在部分EHPVO，巨大脾肿大和严重脾功能亢进的小儿患者中，确立分流手术与部分脾切除相结合的重要性。方法。接受脾脏切除术的远端脾脏分流术（DSRS）在22例2至17岁的EHPVO患儿中进行。手术指征为脾肿大引起的疼痛和腹部不适，以及伴有白血球减少，血小板减少和贫血的症状性脾功能亢进。通过将血管结扎至尾部三分之二的脾脏进行部分脾切除。用电灼LigaSure进行缺血实质实质分界后，保留20-30％的脾脏组织，然后创建Warren DSRS。术前，术后1个月和术后1年进行血小板，白细胞计数和肝功能检查。手术时及一年后，用身高，体重和体重指数的SD评分（Z评分）评估生长情况。结果。所有患者术后均无明显并发症。将血小板和白细胞计数标准化。分流器的通畅率为100％。观察到两个明显的分流狭窄，并经皮血管成形术成功治疗。在随访期间（1至9年），所有患者均无症状，生活质量和生长均得到改善。结论。我们的研究结果表明，对于因EHPVO引起的巨大脾肿大和严重脾功能亢进的患者，部分切除脾脏的分流手术是一种安全有效的方法。

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