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Compression by hepatic hydatid lesions may invade the portal vein and cause cavernous transformation of the portal vein (CTPV), which has difficulties and high risks in surgery, and conventional hepatectomy cannot achieve radical treatment. This article reviews the etiology, classification, clinical manifestations, and auxiliary examinations of hepatic echinococcosis with CTPV and summarizes the treatment strategies for this disease. It is believed that the treatment of hepatic echinococcosis with CTPV should combine the resection of hydatid lesions with the effective relief of portal hypertension, and revascularization and ex-vivo liver resection with auto-transplantation play an important role in radical resection.
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OBJECTIVE@#To assess the clinical application of preoperative retrograde portal venography for children with cavernous transformation of the portal vein (CTPV).@*METHODS@#The clinical data of 8 cases of CTPV admitted in the Children's Hospital of Zhejiang University from January 2018 to September 2019 were retrospectively analyzed. Preoperative retrograde portography was performed to determine the corresponding vascular morphology and size of portal vein system. If the retrograde portography showed that the left branch of the shadow portal vein was unobstructed and its diameter was greater than 3 mm, Rex shunt would be performed after anatomic exploration of Rex recess; if retrograde portography showed that the diameter of left portal vein was less than 3 mm, but the diameter of left renal vein dissected during shunt operation was greater than 5 mm, Warren operation was selected. The patients were followed up for 1, 3 and 6 months after discharge, and then were followed up every 6 months.@*RESULTS@#Retrograde portal venography was successfully performed in 8 child patients.The anatomical position and size of main portal vein and its left and right branches, left renal vein and other important vessels were determined. Among them, there was the well-developed left and right branches of portal vein in 4 child patients, in which the left and right branches of portal vein converged together, but did not communicate with the main portal vein. In addition, the left branch diameter of the portal vein was greater than 3 mm, and the anatomical exploration results during shunt were consistent with it, so Rex shunt was performed. In the other 4 cases, the left branch diameter of the portal vein was small (less than 3 mm) in 3 cases, and the right branch was not clearly developed. Moreover, the left branch of the portal vein was poorly developed and almost occluded in 1 case. However, the left renal vein in these 4 child patients was well developed, the blood flow was unobstructed and the diameter was greater than 5 mm, so Warren operation was performed. Seven patients recovered well after the operation, and the other one had digestive tract rudimentary one year after operation, and the condition was stable after conservative treatment.@*CONCLUSIONS@#The preoperative retrograde portal venography can be used to evaluate the portal vein system in children with CTPV, which provides important clinical basis for making appropriate treatment plan before surgery.
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Child , Humans , Portal Vein/surgery , Portography , Retrospective StudiesABSTRACT
Objective To study the therapeutic efficacy of Rex shunt in treating pediatric patients with prehepatic portal hypertension (PHPH).Methods Five children with PHPH who were admitted from October 2014 to May 2015 were reviewed.There were three boys and two girls,with age ranging from 50 to 95.5 months [(75.8 ± 1.9) months].They all suffered from recurrent upper gastrointestinal (GI) bleeding.Their red blood cell (RBC),white blood cell (WBC) and platelet (PLT) counts were decreased,but laboratory findings revealed no liver dysfunction.Ultrasound and CT scan diagnosed cavernous transformation of portal vein (CTPV) and splenomegaly.The mean splenic length was (42.8 ± 8.2) cm.Indirect portal venography revealed patent left portal vein.All patients underwent Rex shunt and were followed up for 3 ～ 7 months.Results The mean duration of operation was (566.0 ± 39.7) min.Intraoperative bleeding varied from 10 to 50 ml.The portal pressure significantly decreased after surgery from [(25.6 ± 1.5) mmHg,1 mmHg =0.133 kPa] preoperatively to (19.2 ± 3.3) mmHg postoperatively (P ＜ 0.05).Portal venography indicated patent left portal vein after the Rex shunt.The postoperative course was uneventful in the five patients with a mean hospital stay of (26 ± 9.3) days.There was no further GI bleeding.The RBC,WBC and PLT counts increased.Ultrasound indicated patent anastomotic stomas and decreased splenic size.Conclusion A Rex shunt in treating patients with PHPH is safe,feasible and efficacious.
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Objective To explore the efficacy and safety of percutaneous transhepatic portal vein or transjugular intrahepatic portosystemie shunt (TIPS)to implant the portal vein metallic stent in treatment of cavernous transformation of portal vein (CTPV).Methods Clinical and imaging data of 8 patients with CTPV were retrospectively analyzed who were treated in our hospital.All patients were treated with metallic stent implantation in portal vein including 3 patients by TIPS and 5 by percutaneous transhepatic portal vein.Results All patients were successful in the stent implantation without any occurrence of serious complications such as intra-abdominal hemorrhage and so on.Intraoperative angiography showed blood circulated freely in these stents.1 day-2 weeks later,the patients symptoms of abdominal pain and gastrointestinal bleeding were obviously relieved or disappeared.Follow up 1 month-3 years,1 patient with stent occlusion after one year of operation,the blood flow recovery after stent reimplantation,and the remaining patients,color doppler ultrasound reflected patency of blood flows in their stents.No one suffered from gastrointestinal bleeding or abdominal pain again.Conclusion Implantation of portal vein metallic stent via percutaneous transhepatic portal vein or via TIPS in treatment of cavernous transformation of portal vein is safe and effective.
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Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein balloon angioplasty in treating cavernous transformation of portal vein following operation of congenital choledochal cyst. Methods From 2012 to 2014, a total of 6 patients with cavernous transformation of portal vein which occurred after the operation of congenital choledochal cyst were encountered at authors’ hospital. The clinical data were retrospectively analyzed. Before treatment, all patients presented symptoms of different degrees of hematemesis. Percutaneous transhepatic portal vein balloon angioplasty was carried out in all patients, and embolization of gastric coronary vein with coils was employed if angiography showed that coronary vein of stomach was pronouncedly dilated. The clinical manifestations, the imaging materials and the complications were analyzed. All the patients were followed up for 3 - 31 months. Results Of the 6 patients, portal vein main stem occlusion was found in 5 and severe localized stenosis was seen in one. Cavernous transformation of portal vein was revealed in all the 6 patients. Percutaneous transhepatic portal vein balloon angioplasty was successfully accomplished in 5 patients and failed in one patient. Embolization of gastric coronary vein with coils was performed in two patients. After the treatment, no treatment-related severe complications occurred in all patients. The follow-up period ranged from 3 to 31 months. During the follow-up period portal vein maintained patent in 5 patients. No recurrent hematemesis occurred in all patients. Conclusion For the treatment of cavernous transformation of portal vein occurring after the operation of congenital choledochal cyst, percutaneous transhepatic portal vein balloon angioplasty is a safe, effective and minimally - invasive therapeutic means.
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Objective To retrospectively analyze the therapeutic effect of ligaturing pericardial blood vessel combined splenectomy for treating children with gastrointestinal bleeding and hypersplenism secondary to cavernous transformation of portal vein (CTPV).Methods Retrospectively analyzed 30 cases of children with CTPV admitted by Beijing Children's Hospital in General Surgery Department from Jan.2005 to Dec.2012,and evaluated the clinical efficacy of ligaturing pericardial blood vessel combined splenectomy for treating children with gastrointestinal bleeding and hypersplenism secondary to CTPV.Results All of 30 cases admitted operation without serious complication.All children admitted follow-up from 6 to 60 months.Seven cases of 22 patients with gastrointestinal bleeding relapsed bleeding post operation and were cured by conservative treatment.Four cases of 7 relapsing bleeding children had NSAID.All cases of 8 children with simple hypersplenism suggested normal results of blood routine post operation,2 children occurred bloody stools who were cured by conservative treatment.None of patients had serious infection correlating with splenectomy.The size of spleen of patients with gastrointestinal bleeding is larger than patients with simple hypersplenism.Conclusions (1) Ligaturing pericardial blood vessel combined splenectomy is a good choice for children with gastrointestinal bleeding and hypersplenism secondary to CTPV.(2) NSAID may increase the recurrence rate of gastrointestinal bleeding post operation.(3) There may be a negative correlation between the size of spleen and the risk of gastrointestinal bleeding for children with CTPV.
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Extensive thrombosis of the portal and splenomesenteric veins combined with cavernous transformation of the portal vein (CTPV) has been considered to be a contraindication for living donor liver transplantation (LDLT) due to technical difficulties and perioperative risks. In recent years, several surgical innovations including cavoportal hemitransposition, renoportal anastomosis, and portal arterialization have been introduced to overcome diffuse portal vein thrombosis (PVT) and CTPV, but their outcomes were unsatisfactory with significant morbidity and mortality. Herein, we report two successful cases of adult LDLT in diffuse PVT with CTPV managed using the paracholedochal vein as portal inflow to the graft.
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Adult , Humans , Liver Transplantation , Living Donors , Mortality , Portal Vein , Thrombosis , Transplants , Veins , Venous ThrombosisABSTRACT
The main clinical symptoms of the patients are upper gastrointestinal tract haematemesis,hypersplenotrophy and hypersplenia.Most cases can be detected by ultrasonography,digital subtraction angiography(DSA),multislice CT(MSCT) or magnetic resonance angiography(MRA).Rex surgery,Hassab surgery or combination the shunt and disconnection combined operation et al are the preferred operation,therapy for children's cavernous transformation of portal vein will be further developed.The relevant literatures were collected in recent years to review the advancement of surgical therapy for children's cavernous transformation of portal vein.
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Cavernous transformation of portal vein accounts for about 40％ in children portal hypertension.Compared with other causes of portal hypertension disease cavernous transformation of portal vein presents early age of disease onset,high risk of bleeding and normal liver function.Because the pathology is relatively simple and most children have no other diseases,so a reasonable treatment of the disease has decisive significance.The current concept for diagnosis and treatment of the disease is different between home and abroad,Controlling upper gastrointestinal bleeding is the main purpose in out country.Reliving hypersplenism,improving liver blood supply and quality of life are much important abroad,The article aims to summarize latest foreign literature to introduce latest research for the disease abroad.
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Objective To summarize the diagnosis and surgical treatment of the cavernous transformation of portal vein (CTPV). Methods Clinical data of 63 patients with adult CTPV trea-ted in our hospital from 1976 to 2006 were retrospectively analyzed. Results The diagnosis of CT-PV was comfirmed according to (1) The main symptoms were repeated haematemesis, hemafecia, hy-persplenotrophy, hypersplenia and normal hepatic function. (2) B uhrasonography or ultrasonic Doppler manifested that portal vein thinning or obstruction or embolism, honeycomb appearance con-duit can be seen around. Portal vein frequency spectrum can be seen in the honeycomb appearance con-duit. (3) CT and MR scan materials were exhibited that the main portal vein and its branches lost the normal shape and had the shaggy edge. (4) percutaneous splenoportography or selective arteriography of superior mesenteric artery showed that occlusion of the main branch of portal vein at the porta hepa-tis was revealed, and a masslike network of tortuose veins around the porta hepatis and many small ir-regular veins radiating from the network to the liver were demonst rated. Splenectomy and devaseu-larization was performed in 23, spleneetomy and splenorenal shunt in 32, portal systemic shunt plus porta-azygous devascularization in 8. Portal hypertension was treated first in CTPV with disease of biliary tract. No death happened. The rascult of haemogram recovered in a short period of time.Conclusion Once the patients are diagnosed to suffer from adult CTPV, they should receive explora-tory laparotomy. It is important to choose the most effective treating method for the disease.
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Objective To investigate the appropriate reconstruction techniques of multi-detector-row spiral CT angiography (MDCTA) to depict the collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC). Methods MDCTA scanning was performed during the portal venous phase after intravenous contrast materials in 18 HCC patients with CTPV induced by tumor thrombosis. Raw data were reconstructed with thin slice thickness followed by 2D and 3D angiographic reconstruction methods, including maximum intensity projection(MIP), shade surface display (SSD) and volume rendering technique(VRT). Results MDCTA with MIP reconstruction accurately depicted both the tumor thrombus within the portal vein and the collateral vessels of CTPV including the biliary (cystic vein and pericholedochal veinous plexus) and the gastric (left and right gastric veins) branches. However, VRT and SSD methods did poorly in showing the tumor thrombus and the collateral vessels. Conclusion MDCTA with MIP reconstruction is the method of choice to evaluate the collateral vessels of CTPV.