Portal Vein Thrombosis in Sudanese Children
Portal Vein Thrombosis in Sudanese Children
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苏丹儿童门静脉血栓形成
DOI：
10.4314/sjms.v7i1
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发表时间：
2012
影响因子：
0.5
通讯作者：
M. Gadour
中科院分区：
文献类型：
--
作者：
OM Sabir;YM Al Hag;M. Gadour
背景：门静脉血栓形成（PVT）是苏丹儿童门静脉高压症最常见的原因之一。目的：确定苏丹一家医院儿童PVT的发病率、病因和表现方式，并找出其与胃肠道出血的关系。方法学：这是一项在苏丹喀土穆三级儿科医院（Gaffer Ibn Oaf Specialized Children Hospital（GIO））进行的前瞻性医院研究。350名儿童被诊断为门静脉高压症的临床原因（血崩，脾肿大）。经实验室检查（CBC、LFT、凝血特征和RFT）、腹部多普勒超声检查后，275例患者转为门静脉血栓形成。对所有患者进行上消化道内窥镜检查，并在有指征时进行肝活检。对数据进行分析、讨论并得出结论。结果如下：在800例上消化道出血的儿童中，350例被诊断为门静脉高压症所致食管静脉曲张出血（44%），其中250例（70%）儿童被发现门静脉高压症的原因是PVT，另外25例儿童被诊断为PVT而无消化道出血。年龄4个月~ 16岁。200人是男性。其中75人年龄在1岁以下。仅68例患儿有PVT危险因素史。所有出血者在普萘洛尔和H2受体阻滞剂或PPI的基础上进行硬化治疗、结扎或两者兼而有之。随访6个月~ 4.5年。150名儿童通过4-6次硬化剂治疗、结扎或两者同时进行清除了静脉曲张，其余儿童仍在接受硬化剂治疗。10例因门脉性胆道疾病接受肝脏支持，5例因脾功能亢进接受脾切除术。四个孩子死了。普萘洛尔停止在50名儿童中的150名儿童清除静脉曲张两年后结论：儿童PVT是常见的苏丹儿童，并代表第二常见的上消化道出血的原因。其病因在大多数情况下是模糊的，需要更多的研究和设施来揭示根本原因。简单的临床资料，超声检查和上消化道内镜检查是相当足够的措施，以达到准确的诊断。内镜下硬化疗法和带结扎术与心得安的组合是非常有效的控制食管静脉曲张出血，虽然它有一个受影响的儿童的生活质量显着的影响。因此，需要适当的替代医学或手术治疗，以降低发病率和死亡率，提高这些患者的生活质量。
Background : Portal Vein Thrombosis (PVT) is one of the most common causes of portal hypertension among children in Sudan. Objectives : To determine the incidence, aetiology and mode of presentation of PVT among children and find its relation to gastrointestinal bleeding in a Sudanese hospital. Methodology : This is a prospective hospital based study conducted at a tertiary care paediatric hospital in Khartoum, Sudan (Gaffer Ibn Oaf Specialized Children Hospital (GIO)). 350 children were diagnosed on clinical grounds (heamatemiss, splenomegaly) to have portal hypertension. After laboratory investigations (CBC, LFTs, coagulations profile and RFTs), abdominal sonography with Doppler, 275 patients turned to have portal vein thrombosis. Upper GI endoscopy was done for all patients and liver biopsy when indicated. Data were analysed, discussed and conclusion were reached. Results : Out of 800 children presented with upper GI bleeding 350 were diagnosed as having esophageal varices bleeding due to portal hypertension (44%), out of these 250 (70%) children were found to have PVT as a cause of their portal hypertension, and another 25 children were diagnosed to have PVT without GI bleeding. Their ages ranged between 4 month and 16 years. Two hundred were males. Seventy five were below one year of age. History of risk factor for PVT was found only in 68 children. All the bleeders had sclerotherapy, band ligation or both beside propranolol and H2 blockers or PPI. Time for follow up was between 6 month and 4.5 years. 150 children cleared their varices with 4-6 cession of either sclerotherapy, banding or both, the rest of the children are still receiving sclerotherapy. Ten children received liver support for portal biliopathy, five children had splenectomy because of hypersplenism. Four children died. Propranolol was stopped in 50 children out of 150 children who cleared their varices after two years Conclusions : PVT in children is common in Sudanese children, and represents the second common cause of upper GI bleeding. Its aetiology is obscure in the majority of cases and more studies and facilities are needed to uncover the underlying cause. Simple clinical data, ultrasonography and upper GI endoscopy are quite adequate measures to reach accurate diagnosis. Combinations of endoscopic sclerotherapy and band ligations with propranolol are very effective in controlling the bleeding of the esophageal varices, though it has a remarkable effect on the quality of life of affected children. Thus appropriate medical alternative or surgical treatments are needed in order to reduce morbidity and mortality and improve the quality of life of these patients.