肝外门静脉阻塞的手术结果:审计从三级转诊中心在印度东部。

IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Annals of hepato-biliary-pancreatic surgery Pub Date : 2023-11-30 Epub Date: 2023-06-20 DOI:10.14701/ahbps.23-025
Somak Das, Tuhin Subhra Manadal, Suman Das, Jayanta Biswas, Arunesh Gupta, Sreecheta Mukherjee, Sukanta Ray
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引用次数: 0

摘要

背景/目的:肝外门静脉阻塞(EHPVO)是印度儿童门静脉高压最常见的原因。虽然内窥镜检查是主要的治疗方式,但一小部分患者需要手术。本研究旨在报告手术治疗EHPVO患者的短期和长期结果。方法:回顾性分析2007年8月至2021年12月期间接受手术治疗的所有EHPVO患者。Clavien-Dindo术后并发症分类。使用Wald方法中的二元逻辑回归来确定导致不良结果的预测因素。结果:202例EHPVO患者接受手术治疗。患者平均年龄20.30±9.96岁,病程90.05±75.13个月。最常见的手术指征是门脉胆道病(n = 59, 29.2%),其次是出血(n = 50, 24.8%)。166例患者(82.2%)行分流术。脾切除术合并食管胃断流术是第二常见的手术(n = 20, 9.9%)。8例(4.0%)患者出现9例术后主要并发症(Clavien-Dindo > 3),其中1例(0.5%)手术死亡。中位随访56个月(15-156个月),166例(82.2%)患者预后良好。在多因素分析中,相关脾动脉瘤(p = 0.007)、孤立性胃静脉曲张(p = 0.004)、术前内镜逆行胆管造影和支架置入术(p = 0.015)和分流管闭塞(p < 0.001)是不良长期预后的独立预测因素。结论:手术治疗EHPVO是安全的,对有症状的EHPVO患者具有良好的短期和长期预后,可以考虑进行二级预防。
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Surgical outcome of extrahepatic portal venous obstruction: Audit from a tertiary referral centre in Eastern India.

Backgrounds/aims: Extra hepatic portal venous obstruction (EHPVO) is the most common cause of portal hypertension in Indian children. While endoscopy is the primary modality of management, a subset of patients require surgery. This study aims to report the short- and long-term outcomes of EHPVO patients managed surgically.

Methods: All the patients with EHPVO who underwent surgery between August 2007 and December 2021 were retrospectively reviewed. Postoperative complications were classified after Clavien-Dindo. Binary logistic regression in Wald methodology was used to determine the predictive factors responsible for unfavourable outcome.

Results: Total of 202 patients with EHPVO were operated. Mean age of patients was 20.30 ± 9.96 years, and duration of illness, 90.05 ± 75.13 months. Most common indication for surgery was portal biliopathy (n = 59, 29.2%), followed by bleeding (n = 50, 24.8%). Total of 166 patients (82.2%) had shunt procedure. Splenectomy with esophagogastric devascularization was the second most common surgery (n = 20, 9.9%). Nine major postoperative complications (Clavien-Dindo > 3) were observed in 8 patients (4.0%), including 1 (0.5%) operative death. After a median follow-up of 56 months (15-156 months), 166 patients (82.2%) had favourable outcome. In multivariate analysis, associated splenic artery aneurysm (p = 0.007), isolated gastric varices (p = 0.004), preoperative endoscopic retrograde cholangiography and stenting (p = 0.015), and shunt occlusion (p < 0.001) were independent predictors of unfavourable long-term outcome.

Conclusions: Surgery in EHPVO is safe, affords excellent short- and long-term outcome in patients with symptomatic EHPVO, and may be considered for secondary prophylaxis.

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