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目的 探讨小儿肝外门静脉高压经Rex手术治疗后门静脉高压复发的原因及防治策略.方法 2008年10月至2014年1月,46例患儿(男30例,女16例)因“门静脉海绵样变”就诊于我院,均采用Rex手术治疗.其中采用胃冠状静脉作为分流血管21例,肠系膜下静脉分流2例,脾静脉及其分支分流10例,胃右静脉分流2例,胃冠状静脉胃右静脉弓分流5例,胃网膜右静脉分流1例,采用肠系膜上下静脉及其分支静脉作为桥静脉将门静脉主干与门静脉左支吻合5例.术后对所有患儿跟踪随访,内容包括:B型超声检查评估脾脏大小,分流血管及肝内分支通畅情况;血常规、血生化;上消化道出血表现,生长发育情况.结果 迄今随访4～67个月,平均28.5个月.随访期间,7例患儿术后因出现呕血、黑便等上消化道出血表现入院,常规行腹部B型超声及腹部增强CT观察门静脉分流血管通畅情况.通过检查发现,分流血管狭窄3例,门静脉左支狭窄或闭锁2例,分流血管血栓形成2例.1例采用Rex手术治疗,2例采用Warren手术治疗,4例保守治疗.所有复发患儿随访至今未再出现上消化道出血表现.结论 小儿肝外门静脉高压Rex术后复发的主要原因为分流血管狭窄、门静脉肝内部狭窄或闭锁和分流血管血栓形成.手术应严格掌握适应证,根据具体情况合理选择术式,并注意术后抗血栓治疗,有助于术后恢复和减少复发机会.“,”Objective To explore the etiology and treatment for recurrent portal hypertension after Rex shunting in children.Methods From October 2008 to January 2014,46 children (30 boys,16 girls) with extrahepatic portal hypertension underwent Rex shunting,including gastric coronary vein (n =21),inferior mesenteric vein (n =2),splenic vein & branches (n =10),right gastric vein (n =2),right gastric vein arch (n =5),right gastric epiploic vein (n =1) and aortic trunk-left aortic branch anastomosis (n =5).Follow-ups of splenic ultrasound,blood routine & biochemistry and growth & development were conducted.Results During a mean follow-up period of 28 (54-67)months,7 children of postoperative upper gastrointestinal hemorrhage (hematemesis & melena) were hospitalized.There were shunt stenosis (n =3),stenosis or atresia of left portal vein (n =2) and shunt thrombosis (n =2).And the shunts were Rex (n =1) and Warren (n =2).Four patients received medication and transfusion.There was no recurrence of gastrointestinal hemorrhage.Conclusions The causes of recurrent portal hypertension are shunt stenosis and thrombosis.And the preventive measures include postoperative anti-coagulation and complying with the indication for Rex shunting.