Novosti
|
This journal is indexed in Scopus |
|---|
Year 2012 Vol. 20 No 4
PEDIATRIC SURGERY
A. V. ZAPOLYANSKY 1, V. I. AVERIN 2, Å. M. KOLESNIKOV 2,O. YU. KOROSTELEV 1
CLINICAL PECULIARITIES OF THE EXTRAHEPATIC PORTAL HYPERTENSION IN CHILDREN
ME “The 1st City Clinical Hospital”, Children’s Surgical Centre 1,
EE “Belarusian State Medical University” 2, Minsk,
The Republic of Belarus
Objectives. To make the analysis of the clinical course of the extrahepatic portal hypertension in children of different ages to determine the optimal surgical treatment strategy.
Methods. The analysis of clinical observations and survey results of 168 patients (91 boys, 77 girls) with the portal hypertension, who underwent treatment at the Children’s Surgical Centre in Minsk (2000 – 2007 years). General clinical tests, ultrasound examination of the abdominal organs, esophagogastroduodenoscopy, splenoportography, hepatic biopsy have been used to diagnose the diseases and to evaluate severity of its course.
Results. Blood flow problems from portal vein through the liver into the inferior vena cava was considered as the main reason of child’s portal hypertension. Extrahepatic block of the portal blood flow was diagnosed in 86,3% of patients. The main trigger factors of extrahepatic portal hypertension development were the purulent-septic diseases in infancy and the umbilical vein catheterization revealed in 41,3% of the examined patients. These factors contribute to portal vein thrombosis development with the consequent partial recanalization and the formation of obstructive block portal blood.
Direct statistically significant correlation association between the portal hypertension course severity (stage) and the varicosity degree of the esophageal veins have been revealed. Esophageal-gastric bleeding occurred most frequently – 76,8% – over the age of 1 to 7 years and was considered to be the first clinical symptom in most patients (58,3%).
In the dynamic observation it is appeared the frequency of bleeding usually reduces with increasing age.
Conclusions. The high frequency of bleeding in early childhood requires the early surgical treatment of this patients’ group. Severe course of extrahepatic portal hypertension, a high degree of disability due to this disease and the risk of life-threatening complications development imperatively demand on the special medical care for these patients on the basis of major medical institutions.
1. Razumovskii AIu. Nekotorye voprosy khirurgicheskogo lecheniia portal'noi gipertenzii u detei [Some aspects of surgical treatment of portal hypertension in children] Det khirurgiia. 1998;(3):56–59.
2. Garcia-Tsao G. Portal hypertension. Curr Opin Gastroenterol. 2000 May;16(3):282–89.
3. Sarin SK. Kumar A. Noncirrhotic portal hypertension. Clin Liver Dis. 2006 Aug;10(3):627–51.
4. Seniakovich VM, Leont'ev AF. Klinika, diagnostika, khirurgicheskoe lechenie detei s portal'noi gipertenziei [The clinic, diagnosis, surgical treatment of children with portal hypertension]. Pediatriia. 1999;(2):19–21.
5. Khaderi S, Barnes D. Preventing a first episode of esophageal variceal hemorrhage. Cleve Clin J Med. 2008 Mar;75(3): 235–44.
6. Molleston JP. A new review of portosystemic shunts in children. J Pediatr Gastroenterol Nutr. J Pediatr Gastroenterol Nutr. 2005 Feb;40(2):237–38.
7. Patsiora MD. Khirurgiia portal'noi gipertenzii [Surgery of portal hypertension]. Ìoscow, RF: Meditsina, 1974. 232 p.
8. Katsutoshi O. Hemodynamic mechanism of esophageal varices: [Review]. Dig Endosc. 2006;8(1):6–9.
220116, Respublika Belarus, Minsk, pr-t. Dzerzhinskogo, d. 83, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», kafedra detskoy hirurgii,
e-mail: averinvi@mail.ru,
Averin Vasiliy Ivanovich
Averin V.I., Doctor of Medical Sciences, Professor, Head of the Pediatric Surgery Chair of EE “Belarusian State Medical University”
Zapolyansky A.V., Candidate of Medical Sciences, Pediatric Surgeon of the Surgical Department ¹2 of ME “The 1st City Clinical Hospital”, Children’s Surgical Centre.
Kolesnikov E.M., Candidate of Medical Sciences, Associate Professor of the Pediatric Surgery Chair of EE “Belarusian State Medical University”
Korostelev O.YU., Pediatric Surgeon of the Surgical Department ¹2 of ME “The 1st City Clinical Hospital”, Children’s Surgical Centre
Article in the .pdf format
