Recently, the pediatric surgery team of Shanghai Children's Medical Center and Guizhou Provincial People's Hospital successfully operated on a patient with portal cavernous lesions accompanied by portal hypertension and esophageal and gastric varices, who was only 3 years old.
It is understood that the child suddenly vomited a large amount of blood a month ago, accompanied by nosebleeds, bleeding of 300ml, parents immediately took the child to Shanghai Children's Medical Center Guizhou Hospital, Guizhou Provincial People's Hospital for treatment, after the pediatric physician actively rescued, the child's bleeding gradually stopped. After further examination, the doctor found that the child had a rare disease - "portal cavernous change with portal hypertension and esophageal and gastric varices", and the patient was subsequently admitted to the pediatric surgery ward of the hospital.
The hospital's medical team immediately organized a remote network consultation with Professor Yan Zhilong, a general surgeon at Shanghai Children's Medical Center, who believed that the patient's condition was serious and needed to undergo Rex surgery immediately. Rex shunt is the standard procedure for the treatment of this condition, which is a four-stage procedure that is difficult, risky and extremely challenging. This procedure has a significant effect on correcting portal cavernous changes and is in line with physiological functions, but the operation is difficult.
After full preparation, Professor Yan Zhilong of Shanghai Children's Medical Center, Chief Physician Tang Yingming and Chief Physician Chen Sheng of Pediatric Surgery jointly completed the operation for the patient, and the patient recovered well after the operation, which greatly improved the problems of portal hypertension and esophageal and gastric variceal bleeding.
Preoperative (left), contrast showed portal vein main trunk blockage, local "sponge-like" changes; After surgery (right), contrast showed patency of the bypass vessels and the portal veins in the liver
"Children's portal cavernous lesions refer to different degrees of obstruction of the main trunk of the portal vein caused by various reasons, and the liver in order to ensure normal portal vein blood perfusion and compensatory structural changes around the portal vein, forming a large number of dilated tortuous collateral vascular plexuses to the liver, which is named for similar spongy in CT and MRI examinations, and is the main cause of portal hypertension in children. Common causes of portal cavernous changes include portal vein embolism, congenital developmental abnormalities, hepatic vein obstructive diseases, various blood system diseases, surgical injuries, umbilical phlebitis, portal phlebitis, etc., and children may have gastrointestinal bleeding, splenomegaly, hypersplenism, etc. at different stages of the disease," the surgeon introduced.
According to He Guoqing, director of the provincial pediatric surgeon, the clinical diagnosis of portal cavernous lesions in children is not difficult, but it is rare, and early diagnosis and selection of appropriate treatment measures are very important to improve the prognosis of children. This operation marks a new height in the diagnosis and treatment of this rare disease in the hospital's pediatric surgery.
In the future, Guizhou Hospital of Shanghai Children's Medical Center will be built into an integrated center of children's medicine, scientific research and teaching, a national tertiary pediatric specialty hospital and a national regional pediatric specialty diagnosis and treatment center, radiating the margins of the four provinces of Yunnan, Guichuan and Xiang, fully reaching the functional positioning and development level of the national regional medical center, realizing the balanced distribution of medical resources, and ensuring that serious diseases do not leave the province.
(Reporter: Zhou Qian)