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目的 探讨小儿门脉高压症肝内、外型的特点及其外科治疗的效果。方法 对 10 2例小儿门脉高压症进行回顾性研究。肝内型 5 0例 ,肝外型 46例 ,不明 6例。肝内型平均年龄大于肝外型 (P <0 .0 5 )。有食管静脉曲张破裂出血者 6 0例 (6 2 .5 % ) ,肝外型出血率大于肝内型 (P <0 .0 5 )。肝功能属ChildA和B者共 87例。 89例施行了各种手术 96次。结果 除 1例死于肝衰竭外 ,其余88例痊愈出院。术后 82例 (93.2 % )获访 ,随访时间 0 .5～ 34年 (平均 11.6 7年 )。术后再出血者 31例(32 .3% ) ,肝外型出血率大于肝内型 (P <0 .0 5 )。死亡 16例 (18.0 % ) ,肝内型病死率明显大于肝外型 (P <0 .0 1)。生存病例均能参加正常学习和工作。本组有 2 5例已结婚 ,其中 2 1例已生子 ,2人已生孙。结论 肝内、外型门脉高压症的发病年龄、发生食管静脉曲张出血率及外科治疗预后等均有差别。防治静脉曲张破裂出血是本病的治疗重点 ,联合手术应列为首选。术后再出血病例应考虑做食管贲门胃底切除术。对肝内型门脉高压症术应加强保肝治疗
Objective To investigate the characteristics of liver and appearance in children with portal hypertension and the effect of surgical treatment. Methods A retrospective study of 102 cases of pediatric portal hypertension. 50 cases of intrahepatic, extrahepatic 46 cases, unknown 6 cases. The average intrahepatic type was longer than that of the liver (P <0.05). There were 60 cases of esophageal variceal bleeding (62.5%), the extrahepatic bleeding rate was greater than that of intrahepatic type (P <0.05). A total of 87 cases of ChildA and B liver function. 89 cases performed a variety of operations 96 times. Results except one died of liver failure, the remaining 88 patients were discharged. 82 cases (93.2%) were followed up for 0.55 to 34 years (average 11.67 years). There were 31 cases (32.3%) of rebleeding after operation, and the extrahepatic bleeding rate was larger than that of intrahepatic type (P <0.05). There were 16 deaths (18.0%), and the intrahepatic mortality was significantly greater than that of the liver (P <0.01). Survival cases can participate in normal learning and work. Twenty-five people in this group have been married, of whom 21 have children and 2 have grandson. Conclusions The age of onset of liver and appearance of portal hypertension, the incidence of esophageal varices bleeding and the prognosis of surgical treatment are different. Prevention and treatment of variceal bleeding is the focus of treatment of this disease, the joint surgery should be listed as the first choice. Postoperative bleeding should be considered esophageal esophageal resection. Intrahepatic portal hypertension should be enhanced liver protection treatment