Background

Extrahepatic portal vein obstruction (EHPVO) results in severe portal hypertension (PHT) leading to severely compromised quality of life. Often, pharmacological and endoscopic management is unable to solve this problem. Restoring hepatic portal flow using meso-Rex bypass (MRB) may solve it. This procedure, uncommon in adult patients, is considered the treatment of choice for EHPVO in children.

Methods

From 1997 to 2018, 8 male and 6 female adults, with a median age of 51 years (range 22–66) underwent MRB procedure for EHPVO at the University Hospitals Saint-Luc in Brussels, Belgium. Symptoms of PHT were life altering in all but one patient and consisted of repetitive gastro-intestinal bleedings, sepsis due to portal biliopathy, and/or severe abdominal discomfort. The surgical technique consisted in interposition of a free venous graft or of a prosthetic graft between the superior mesenteric vein and the Rex recess of the left portal vein.

Results

Median operative time was 500 min (range 300–730). Median follow-up duration was 22 months (range 2–169). One patient died due to hemorrhagic shock following percutaneous transluminal intervention for early graft thrombosis. Major morbidity, defined as Clavien-Dindo score ≥ III, was 35.7% (5/14). Shunt patency at last follow-up was 64.3% (9/14): 85.7% (6/7) of pure venous grafts and only 42.9% (3/7) of prosthetic graft. Symptom relief was achieved in 85.7% (12/14) who became asymptomatic after MRB.

Conclusions

Adult EHPVO represents a difficult clinical condition that leads to severely compromised quality of life and possible life-threatening complications. In such patients, MRB represents the only and last resort to restore physiological portal vein flow. Although successful in a majority of patients, this procedure is associated with major morbidity and mortality and should be done in tertiary centers experienced with vascular liver surgery to get the best results.

中文翻译：

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用于治疗成人肝外门静脉阻塞的 Meso-Rex 旁路（附视频）

背景

肝外门静脉阻塞 (EHPVO) 会导致严重的门静脉高压症 (PHT)，从而严重影响生活质量。通常，药理学和内窥镜管理无法解决这个问题。使用 meso-Rex 旁路 (MRB) 恢复肝门静脉血流可以解决这个问题。这种在成人患者中不常见的手术被认为是儿童 EHPVO 的首选治疗方法。

方法

从 1997 年到 2018 年，8 名男性和 6 名女性成年人，中位年龄 51 岁（范围 22-66 岁）在比利时布鲁塞尔的圣卢克大学医院接受了 EHPVO 的 MRB 手术。除了一名患者，PHT 的症状改变了所有患者的生活，包括反复的胃肠道出血、门脉胆管病引起的败血症和/或严重的腹部不适。手术技术包括在肠系膜上静脉和左门静脉的 Rex 隐窝之间插入游离静脉移植物或人工移植物。

结果

中位手术时间为 500 分钟（范围 300-730）。中位随访时间为 22 个月（范围 2-169）。一名患者因早期移植物血栓形成经皮腔内介入治疗后失血性休克死亡。主要发病率，定义为 Clavien-Dindo 评分 ≥ III，为 35.7% (5/14)。末次随访时分流管通畅率为 64.3% (9/14)：纯静脉移植物为 85.7% (6/7)，人工移植物仅为 42.9% (3/7)。在 MRB 后无症状的 85.7% (12/14) 实现了症状缓解。

结论

成人 EHPVO 代表一种困难的临床状况，会导致严重影响生活质量和可能危及生命的并发症。在此类患者中，MRB 是恢复生理性门静脉血流的唯一也是最后手段。虽然在大多数患者中成功，但该手术与主要的发病率和死亡率相关，应在有血管肝脏手术经验的三级中心进行，以获得最佳效果。