Meso-Rex bypass for the management of extrahepatic portal vein obstruction in adults(with video)

作     者：Martin Brichard Samuele Iesari Jan Lerut Raymond Reding Pierre Goffette Laurent Coubeau Martin Brichard;Samuele Iesari;Jan Lerut;Raymond Reding;Pierre Goffette;Laurent Coubeau

作者机构：Service de Chirurgie et Transplantation AbdominaleCliniques Universitaires Saint-LucUniversitéCatholique de Louvain10 Avenue HippocrateBrussels 1200Belgium Pôle de Chirurgie Expérimentale et TransplantationInstitut de Recherche Expérimentale et CliniqueUniversitéCatholique de LouvainBrusselsBelgium Department of Clinical Sciences and Applied BiotechnologyUniversity of L’AquilaL’AquilaItaly Department of General Surgery and Kidney TransplantationFondazione IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilanItaly Service de Radiologie et Imagerie médicaleCliniques Universitaires Saint-LucUniversitéCatholique de LouvainBrusselsBelgium 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2022年第21卷第1期

页      面：25-32页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：approved by the Ethics Committee of the University Hospitals Saint-Luc in Brussels Belgium(CEHF 2020/22JUL/374) 

主　　题：Meso-Rex bypass Extrahepatic portal vein obstruction Extrahepatic portal hypertension Portal vein thrombosis Surgical procedure 

摘      要：Background:Extrahepatic portal vein obstruction(EHPVO)results in severe portal hypertension(PHT)leading to severely compromised quality of ***,pharmacological and endoscopic management is unable to solve this *** hepatic portal flow using meso-Rex bypass(MRB)may solve *** procedure,uncommon in adult patients,is considered the treatment of choice for EHPVO in ***: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,***-toms 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 *** 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 ***: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 interven-tion for early graft *** 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 *** relief was achieved in 85.7%(12/14)who became asymptomatic after ***:Adult EHPVO represents a difficult clinical condition that leads to severely compromised quality of life and possible life-threatening *** such patients,MRB represents the only and last resort to restore physiological portal vein *** successful in a majority of patients,this procedure is associated with major morbidity and mortality and should be done in tertiary centers expe-rienced with vascular liver surgery to get the best results.