Effect of internal jugular vein bypass Rex surgery on anticoagulant factors and portal pressure in children with extrahepatic portal vein obstruction_West China Medical Journal

Authors：

 ZHANG Xiangning ¹ , SUN Huan ² , HOU Chongzhi ¹ , SHI Weidong ¹ , ZHANG Shufeng ³

1. Section Ⅰ of General Surgery Department, Xi’an Children’s Hospital, Xi’an, Shaanxi 710003, P. R. China;
2. Department of Neonatal Critical Care Medicine, Xi’an Children’s Hospital, Xi’an, Shaanxi 710003, P. R. China;
3. Department of Pediatric Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, P. R. China;

Corresponding author：

ZHANG Xiangning, Email: zhangxiangning_xb@yeah.net

Keywords：

Superior mesenteric vein-left portal branch shunt; Rex surgery; Extrahepatic portal vein obstruction; Protein S; Protein C; Antithrombin Ⅲ

DOI：

10.7507/1002-0179.201911306

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Objective To investigate the effect of Rex surgery (superior mesenteric vein-left portal vein shunt) with internal jugular vein bypass on the anticoagulant factors and portal pressure in children with extrahepatic portal vein obstruction (EHPVO).Methods From January 2014 to December 2018, children with EHPVO in Xi’an Children’s Hospital were retrospectively analyzed. All children underwent Rex surgery. The anticoagulant factors, blood routine indicators, and portal pressure-related indicators of all children were tested before and 1 year after Rex surgery, and the differences were compared. Results A total of 32 children were enrolled, and all children were followed up for 1 year after Rex surgery, and no follow-up was lost. Follow-up ultrasound examination 1 year after surgery showed that the portal vein blood flow in all children was unobstructed, and there was no venous thrombosis. The concentration of protein C, protein S and antithrombin Ⅲ activity of the children 1 year after surgery [(5.91±0.67) μg/mL, (2.43±0.34) μg/mL and (59.64±4.54)%, respectively] were all higher than those before surgery [(3.25±0.82) μg/mL, (2.02±0.37) μg/mL and (50.22±3.91)%, respectively], and the differences were statistically significant (P<0.05). There was no statistically significant difference in the concentration of antithrombin Ⅲ 1 year after surgery compared with that before surgery (P>0.05). The red blood cell count, hemoglobin concentration, white blood cell count and platelet count of the children 1 year after surgery [(4.61±0.17)×10¹²/L, (128.53±6.55) g/L, (6.09±0.72)×10⁹/L and (104.88±5.74)×10⁹/L, respectively] were all higher than those before surgery [(3.78±0.19)×10¹²/L, (105.53±5.31) g/L, (3.39±0.58)×10⁹/L and (87.42±5.53)×10⁹/L, respectively], and the differences were statistically significant (P<0.05). The diameter of the left portal vein 1 year after surgery was larger than that before surgery [(7.23±0.66) vs. (2.30±0.69) mm], the spleen volume was smaller than that before surgery [(55.74±4.07) vs. (67.21±4.22) cm³], and the portal vein pressure was lower than that before surgery [(23.37±1.27) vs. (35.29±1.36) cm H₂O (1 cm H₂O=0.098 kPa)], and the differences were statistically significant (P<0.05). Conclusion Rex surgery with internal jugular vein bypass is beneficial to improving the level of anticoagulant factors in children with EHPVO, improving portal vein blood flow and pressure, and effectively relieving hypersplenism, which has a certain promotion value.

Citation： ZHANG Xiangning, SUN Huan, HOU Chongzhi, SHI Weidong, ZHANG Shufeng. Effect of internal jugular vein bypass Rex surgery on anticoagulant factors and portal pressure in children with extrahepatic portal vein obstruction. West China Medical Journal, 2021, 36(9): 1201-1204. doi: 10.7507/1002-0179.201911306 Copy

1.	温哲, 王哲, 刘涛, 等. 颈内静脉搭桥Rex手术治疗小儿肝外门静脉梗阻的初步探讨. 中华小儿外科杂志, 2016, 37(2): 124-130.
2.	Achar S, Dutta HK, Gogoi RK. Extrahepatic portal vein obstruction in children: role of preoperative imaging. J Indian Assoc Pediatr Surg, 2017, 22(3): 144-149.
3.	Mack CL, Superina RA, Whitington PF. Surgical restoration of portal flow corrects procoagulant and anticoagulant deficiencies associated with extrahepatic portal vein thrombosis. J Pediatr, 2003, 142(2): 197-199.
4.	娄平平. 儿童门静脉海绵样变的临床治疗研究. 河南: 郑州大学, 2018: 4.
5.	张金山, 李龙, 刘树立, 等. 小儿肝外门静脉高压Rex术后门静脉高压复发的临床分析. 中华小儿外科杂志, 2015, 36(12): 894-897.
6.	刘涛, 温哲, 梁奇峰, 等. Rex术治疗儿童门静脉海绵样变疗效分析. 中华肝脏外科手术学电子杂志, 2019, 8(5): 410-414.
7.	张宾宾, 温哲. 儿童肝外门静脉梗阻的外科治疗. 中华肝脏外科手术学电子杂志, 2019, 8(5): 392-395.
8.	El-Karaksy H, El-Koofy N, Mohsen N, et al. Extrahepatic portal vein obstruction in egyptian children. J Pediatr Gastroenterol Nutr, 2015, 60(1): 105-109.
9.	Mir TA, Misgar RA, Laway BA, et al. Prevalence and pattern of growth abnormalities in children with extrahepatic portal vein obstruction: response to shunt surgery. Indian J Endocrinol Metab, 2016, 20(6): 763-766.
10.	D’Cruz AJ, Kamath PS, Ramachandra C, et al. Non-conventional portosystemic shunts in children with extrahepatic portal vein obstruction. Acta Paediatr Jpn, 1995, 37(1): 17-20.
11.	Chiu B, Melin-Aldana H, Superina RA. Human extrahepatic portal vein obstruction correlates with decreased factor Ⅶ and protein C transcription but increased hepatocyte proliferation. J Pediatr Surg, 2007, 42(10): 1768-1771.
12.	Fisher NC, Wilde JT, Roper J, et al. Deficiency of natural anticoagulant proteins C, S, and antithrombin in portal vein thrombosis: a secondary phenomenon?. Gut, 2000, 46(4): 534-539.
13.	刘斐, 王哲, 温哲. Rex分流术治疗小儿肝前性门静脉高压症5例临床分析. 中华肝胆外科杂志, 2016, 22(2): 73-77.
14.	张金山, 李龙, 侯文英. 蛋白C、蛋白S和抗凝血酶Ⅲ与Rex手术预后的关系研究. 中华小儿外科杂志, 2018, 39(10): 734-738.
15.	Khodayar-Pardo P, Peña Aldea A, Ramírez González A, et al. Very early presentation of extrahepatic portal vein obstruction causing portal hypertension in an infant: uncertainties in the management and therapeutic limitations. Case Rep Gastroenterol, 2016, 10(2): 360-365.
16.	Lv Y, He C, Guo W, et al. Transjugular intrahepatic portosystemic shunt for extrahepatic portal venous obstruction in children. J Pediatr Gastroenterol Nutr, 2016, 62(2): 233-241.
17.	张金山, 李龙, 陈震, 等. 肝外门静脉梗阻对抗凝血因子水平的影响. 中华小儿外科杂志, 2019, 40(2): 163-166.
18.	Gürakan F, Koçak N, Yüce A, et al. Extrahepatic portal venous obstruction in childhood: etiology, clinical and laboratory findings and prognosis of 34 patients. Acta Paediatr Jpn, 1997, 39(5): 595-600.
19.	Sharif K, McKiernan P, de Ville de Goyet J. Mesoportal bypass for extrahepatic portal vein obstruction in children: close to a cure for most!. J Pediatr Surg, 2010, 45(1): 272-276.
20.	刘树立, 李龙, 张军, 等. 肠门分流术治疗肝前型门静脉高压分流断流术后复发出血的探讨. 中华小儿外科杂志, 2015, 36(3): 201-205.

1. 温哲, 王哲, 刘涛, 等. 颈内静脉搭桥Rex手术治疗小儿肝外门静脉梗阻的初步探讨. 中华小儿外科杂志, 2016, 37(2): 124-130.
2. Achar S, Dutta HK, Gogoi RK. Extrahepatic portal vein obstruction in children: role of preoperative imaging. J Indian Assoc Pediatr Surg, 2017, 22(3): 144-149.
3. Mack CL, Superina RA, Whitington PF. Surgical restoration of portal flow corrects procoagulant and anticoagulant deficiencies associated with extrahepatic portal vein thrombosis. J Pediatr, 2003, 142(2): 197-199.
4. 娄平平. 儿童门静脉海绵样变的临床治疗研究. 河南: 郑州大学, 2018: 4.
5. 张金山, 李龙, 刘树立, 等. 小儿肝外门静脉高压Rex术后门静脉高压复发的临床分析. 中华小儿外科杂志, 2015, 36(12): 894-897.
6. 刘涛, 温哲, 梁奇峰, 等. Rex术治疗儿童门静脉海绵样变疗效分析. 中华肝脏外科手术学电子杂志, 2019, 8(5): 410-414.
7. 张宾宾, 温哲. 儿童肝外门静脉梗阻的外科治疗. 中华肝脏外科手术学电子杂志, 2019, 8(5): 392-395.
8. El-Karaksy H, El-Koofy N, Mohsen N, et al. Extrahepatic portal vein obstruction in egyptian children. J Pediatr Gastroenterol Nutr, 2015, 60(1): 105-109.
9. Mir TA, Misgar RA, Laway BA, et al. Prevalence and pattern of growth abnormalities in children with extrahepatic portal vein obstruction: response to shunt surgery. Indian J Endocrinol Metab, 2016, 20(6): 763-766.
10. D’Cruz AJ, Kamath PS, Ramachandra C, et al. Non-conventional portosystemic shunts in children with extrahepatic portal vein obstruction. Acta Paediatr Jpn, 1995, 37(1): 17-20.
11. Chiu B, Melin-Aldana H, Superina RA. Human extrahepatic portal vein obstruction correlates with decreased factor Ⅶ and protein C transcription but increased hepatocyte proliferation. J Pediatr Surg, 2007, 42(10): 1768-1771.
12. Fisher NC, Wilde JT, Roper J, et al. Deficiency of natural anticoagulant proteins C, S, and antithrombin in portal vein thrombosis: a secondary phenomenon?. Gut, 2000, 46(4): 534-539.
13. 刘斐, 王哲, 温哲. Rex分流术治疗小儿肝前性门静脉高压症5例临床分析. 中华肝胆外科杂志, 2016, 22(2): 73-77.
14. 张金山, 李龙, 侯文英. 蛋白C、蛋白S和抗凝血酶Ⅲ与Rex手术预后的关系研究. 中华小儿外科杂志, 2018, 39(10): 734-738.
15. Khodayar-Pardo P, Peña Aldea A, Ramírez González A, et al. Very early presentation of extrahepatic portal vein obstruction causing portal hypertension in an infant: uncertainties in the management and therapeutic limitations. Case Rep Gastroenterol, 2016, 10(2): 360-365.
16. Lv Y, He C, Guo W, et al. Transjugular intrahepatic portosystemic shunt for extrahepatic portal venous obstruction in children. J Pediatr Gastroenterol Nutr, 2016, 62(2): 233-241.
17. 张金山, 李龙, 陈震, 等. 肝外门静脉梗阻对抗凝血因子水平的影响. 中华小儿外科杂志, 2019, 40(2): 163-166.
18. Gürakan F, Koçak N, Yüce A, et al. Extrahepatic portal venous obstruction in childhood: etiology, clinical and laboratory findings and prognosis of 34 patients. Acta Paediatr Jpn, 1997, 39(5): 595-600.
19. Sharif K, McKiernan P, de Ville de Goyet J. Mesoportal bypass for extrahepatic portal vein obstruction in children: close to a cure for most!. J Pediatr Surg, 2010, 45(1): 272-276.
20. 刘树立, 李龙, 张军, 等. 肠门分流术治疗肝前型门静脉高压分流断流术后复发出血的探讨. 中华小儿外科杂志, 2015, 36(3): 201-205.

West China Medical Journal

Effect of internal jugular vein bypass Rex surgery on anticoagulant factors and portal pressure in children with extrahepatic portal vein obstruction

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