Extrahepatic portal hypertension (EHPH) is one of the complex pathologies in children, which leads to severe gastrointestinal bleeding. During the period of surgical treatment of portal hypertension, more than a hundred variants of operations have been proposed, but today there is no single method and approach in the treatment and prevention bleeding from variceal vein of esophagus and stomach in children. It is generally accepted that mesoportal shunting (MPS) is the most effective and radical method, but it sis possible only in 25-35% of patients with EHPH. Therefore, a significant role in EHPH surgery is played by portosystemic shunting (PSS), which has proven its effectiveness according to the literature. Splenorenal shunting (SRS) is most commonly used for PSS. However, to date there is no comparison in the literature of different variants of SRS among themselves in terms of the effectiveness of prevention of bleeding from variceal of esophageal and stomach, leveling of clinical manifestations of EHPH and the impact on the rate of portohepatic perfusion (PHP).
There are studies comparing PSS operations with separation operations or endoscopic methods to stop and prevent bleeding from variceal esophageal and stomach. There are no fundamental studies comparing SRS, namely distal splenorenal distal shunting, proximal splenorenal shunting, splenorenal shunting side-by-side to eliminate the main clinical manifestations of EHPH and the effect on PHP.
The paper presents a variant of solving the current scientific and practical issue of improving the effectiveness of treatment of EHPH in children based on improving the indications for SRS and analysis of variants of SRS and comparing them to determine the optimal type of SRS.
The aim of the study was to improve of treatment of the hepatic form of portal hypertension in children by choosing the optimal variant of splenorenal shunting.
Objective of the study:
1. To improve the necessary set of diagnostic measures for verification of morpho-functional changes in the extrahepatic portal hypertension in children.
2. To objective the indications for the choice of splenorenal shunting for the treatment of extrahepatic portal hypertension in children.
3. To study morphological changes in the liver before and after splenorenal shunting in children with extrahepatic portal hypertension.
4. To investigate the clinical effectiveness of using different types of splenorenal shunting in children with extrahepatic portal hypertension.
5. Evaluate hemodynamic changes in portal system after different options for splenorenal shunting.
The dissertation is a clinical, monocentric, retrospective analysis of patients with EHPH by SRS. The design of this study was approved by the Commission on Bioethical Expertise of Scientific Reserch at the National Medical University named O. O. Bogomolets.
Criteria for inclusion in the study were as follows: the presence of hepatic form of portal hypertension; the patient’s age is more than 17 years 11 months and 29 days; the presence of blood flow in the umbilical plateau of the liver; changes in the splenic vein and left renal vein or their diameter is less than 5mm; previous operations on the splenic vein or left renal vein, which led to changes in the vessels, the presence of hepatitis B, C, D, failure to pass control examinations, after the formation of PSS diameter of the left renal vein or branched type of its structure, cicatricial-inflammatory changes of the splenic or left renal vein, intrapancreatic location of the splenic vein.
Our study included 83 patients with EHPH, under the age of 18, who were treated in National Children’s Spesialized Hospital “Okchmatdyt” which is the clinical base of the Department of Pediatric Surgery O.O. Bogomolets, from 2000 to 2010. All children included in the study were performed with different variants of splenorenal shunt.The studied population was divided into three groups. The first included 44 patients who had developed SRS side-by-side, the second group included 27 patients who developed distal splenorenal shunt (DSRS) and the third group included 12 children with proximal splenorenal shunt (PSRS).
The following research methods were used: clinical; laboratory including the level of leukocytes, platelets, erythrocytes, hemoglobin, bilirubin and its fractions, ALT, AST; instrumental (ultrasound examination of abdominal organs with doppler vascular, upper endoscopy, portomanometry, histological examination); statistical methods of processing the obtained results (IBM SPSS Statistics v.22).
