ANALYSIS OF THE DECOMPRESSION PROPERTIES OF MESOCAVAL SHUNTING FOR PORTAL HYPERTENSION IN CHILDREN

Autor: O. G. Dubrovin, A. S. Hodik, V. P. Soruchan, L. E. Azarov
Rok vydání: 2016
Předmět:
Zdroj: Neonatology, surgery and perinatal medicine. 6:34-38
ISSN: 2413-4260
2226-1230
DOI: 10.24061/2413-4260.vi.4.22.2016.4
Popis: Aim: To evaluate the decompression properties of mesocaval shunting (MCS) in children with portal hypertension (PH). Materials and methods: We analyzed the effectiveness of different variants of MCS in 70 children, based on the comparing properties of decompression of MCS, and the change in portohepatic perfusion (PHP) after shunting. Patients were divided into two groups: first- 40 (57,1%) children who underwent H- type MCS (H- MCS); second group- 30 (42,9%) children who had MCS side-to-side (s/s). By retrospective analysis of computed tomography (CT) results in 52 children with portal hypertension (PH) we outlined three types (A, B, C) of the splenomesenteric confluence (SMC). Results: Primarily MCS (n- 33, 47,1%) was conducted in cases when the splenic vein was unfit for shunting. In cases of secondary operations (n- 37, 52,9%) the indication for MCS was unsatisfactory results of primary operation. Comparing different types of MCS the highest decompression (8,4% higher) was seen in cases with MCS s/s. There was no difference in the change of PHP after different types of MCS. Regression of varicose in the esophagus and stomach was seen in all children. Recurrences of bleeding in postoperative period were stated in 12,9% of patients. Based on the anatomical features of the SMC the ability to perform mesocaval shunting (MCS) side-to-side (s/s) or MCS of the H-type (H- MCS) in cases with A and C type of the SMC is almost the same (52,4% and 47,6% with A type SMC; 47,1% and 52,9% with С type SMC). In cases with B type SMC the ability to perform H-MCS is 28,6% higher than performing a MCS s/s. Conclusions: MCS can be considered as a method of choice taking in consideration the anatomic features of the portal vein (PV). Suggested types of MCS ensure decompression of the portal system: pressure decreases by 35,6% after MCS s/s; after H-MCS a 27,2% decrease in pressure is seen. Taking in consideration the change in PHP and the dynamics of varicose regression, MCS is an effective method for preventing or treating bleeding in children with PH, with an ef fectiveness of 84,2%.
Databáze: OpenAIRE
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