PORTAL OBSTRUCTION IN CHILDREN .1. CLINICAL INVESTIGATION AND HEMORRHAGE RISK
PORTAL OBSTRUCTION IN CHILDREN .1. CLINICAL INVESTIGATION AND HEMORRHAGE RISK
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DOI：
10.1016/s0022-3476(83)80460-0
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发表时间：
1983-01-01
影响因子：
5.1
通讯作者：
ALAGILLE, D
中科院分区：
文献类型：
--
作者：
ALVAREZ, F;BERNARD, O;ALAGILLE, D
检查了108例门静脉阻塞儿童。症状包括脾肿大和胃肠道出血。梗阻继发于门静脉损伤44例，合并先天性畸形17例。超声检查提供了正确的诊断在37名儿童中的36人进行。101例患儿的血管造影显示，14例梗阻延伸至上级肠系膜静脉，7例梗阻延伸至整个门静脉系统;半数病例累及肝内分支。自然脾肾分流在19名儿童中可见，但与胃肠道出血的风险较低无明显相关性;在30名儿童中，5名儿童的腔静脉造影显示下腔静脉异常。自发性消化道出血78例。纤维内窥镜检查显示81名儿童中有79名有食管静脉曲张。食管粘膜的紧张性静脉曲张和充血明显增加了出血的风险。这些结果表明，一个简单的调查方法的基础上超声诊断和内镜预后。血管造影应限于有胃肠道出血史的儿童，他们正在考虑手术门体分流。
Children (108) with obstruction of the portal vein were examined. Symptoms included splenomegaly and gastrointestinal tract hemorrhage. Obstruction was secondary to portal vein injury in 44 children and was combined with congenital malformations in 17 others. Ultrasonography provided the correct diagnosis in 36 of 37 children in whom it was performed. Angiography, performed in 101 children, showed that the obstruction extended to the superior mesenteric vein in 14 children and to the entire portal venous system in 7; intrahepatic branches were involved in half the cases. Natural splenorenal shunts were visible in 19 children but were not clearly associated with a lower risk of gastrointestinal tract bleeding; in 5 of 30 children, cavography displayed abnormalities of the inferior vena cava. Spontaneous gastrointestinal tract hemorrhage occurred in 78 children. Fiberoptic endoscopy showed esophageal varices in 79 of the 81 children studied. The presence of tense varices and congestion of esophageal mucosa clearly augmented the risk of bleeding. These results suggest a simple method of investigation based on ultrasonography for diagnosis and endoscopy for prognosis. Angiography should be limited to children with a history of gastrointestinal tract bleeding for whom a surgical portosystemic shunt is being considered.