Abstract

Objective To explore the etiology and treatment for recurrent portal hypertension after Rex shunting in children. Methods From October 2008 to January 2014, 46 children (30 boys, 16 girls) with extrahepatic portal hypertension underwent Rex shunting, including gastric coronary vein (n=21), inferior mesenteric vein (n=2), splenic vein & branches (n=10), right gastric vein (n=2), right gastric vein arch (n=5), right gastric epiploic vein (n=1) and aortic trunk-left aortic branch anastomosis (n=5). Follow-ups of splenic ultrasound, blood routine & biochemistry and growth & development were conducted. Results During a mean follow-up period of 28 (54-67) months, 7 children of postoperative upper gastrointestinal hemorrhage (hematemesis & melena) were hospitalized. There were shunt stenosis (n=3), stenosis or atresia of left portal vein (n=2) and shunt thrombosis (n=2). And the shunts were Rex (n=1) and Warren (n=2). Four patients received medication and transfusion. There was no recurrence of gastrointestinal hemorrhage. Conclusions The causes of recurrent portal hypertension are shunt stenosis and thrombosis. And the preventive measures include postoperative anti-coagulation and complying with the indication for Rex shunting. Key words: Hypertension, portal; Recurrence; Risk Factor; Clinical protocols

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