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Wang RY, Wang JF, Sun XG, Liu Q, Xu JL, Lv QG, Chen WX, Li JL. Evaluation of Rex Shunt on Cavernous Transformation of the Portal Vein in Children. World J Surg 2017; 41:1134-1142. [PMID: 27896406 DOI: 10.1007/s00268-016-3838-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Children with cavernous transformation of the portal vein (CTPV) develop severe complications from prehepatic portal hypertension, such as recurrent variceal bleeding and thrombocytopenia. In this study, we reported the results of 30 children with symptomatic CTPV that were treated by a Rex shunt. The effectiveness of this surgical approach was evaluated. METHODS A retrospective review was performed of 30 children aged between 3 and 18 years with CTPV, who underwent a Rex shunt between 2008 and 2015. All children were evaluated based on symptoms, complete blood count, portal system color-flow Doppler ultrasound or computed tomography angiography portography and gastroscopy for gastroesophageal varices pre- and postoperatively. Children were also evaluated during follow-up. Intraoperative evaluations included liver biopsy, portography and portal pressure. RESULTS Twenty-one patients demonstrated intermittent bleeding from gastroesophageal varices, 3 patients showed hypersplenism with varying degrees of leucopenia, anemia and thrombocytopenia, and in 6 patients both bleeding and hypersplenism were observed. Rex was successful in 28 patients (93.3%). The portal pressure immediately decreased significantly after placing of the shunt (P < 0.01). During the clinical follow-up period within 2-82 months, transaminase levels were maintained in the normal range. Blood flow velocity and diameter of the left portal vein significantly increased after surgery (P < 0.01). In addition, leukocyte and platelet counts increased postoperatively and anemia improved significantly (P < 0.01). Gastroscopy results indicated that the degree of gastroesophageal varices significantly alleviated postoperatively within 3 months and 1 year (P < 0.01). In 2 patients who demonstrated nodular cirrhosis and chronic active hepatitis, success of the Rex shunt was not achieved after operation. We found that for Rex effectiveness hepatic pathology and patient age were major determinants. CONCLUSION Rex shunt is an effective approach for the treatment of children suffering from CTPV at an early stage that do not show additional liver lesions.
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Affiliation(s)
- Ruo-Yi Wang
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, 250033, Shandong, People's Republic of China
| | - Jun-Feng Wang
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, 250033, Shandong, People's Republic of China
| | - Xiao-Gang Sun
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, 250033, Shandong, People's Republic of China
| | - Qian Liu
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, 250033, Shandong, People's Republic of China
| | - Jia-Long Xu
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, 250033, Shandong, People's Republic of China
| | - Qi-Gang Lv
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, 250033, Shandong, People's Republic of China
| | - Wei-Xiu Chen
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, 250033, Shandong, People's Republic of China
| | - Jin-Liang Li
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, 250033, Shandong, People's Republic of China.
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Abstract
OBJECTIVE To assess the iodine nutritional status and investigate the prevalence of thyroid diseases in a community population in Chengdu, China. METHODS Eighty school-age children were randomly selected for measurements of urinary iodine concentration. A total of 1500 residents over the age of 18 who had lived in Chengdu for more than 5 years were selected by stratified cluster sampling. Serum thyroid hormone concentrations and thyroid autoantibodies were measured, and thyroid ultrasonography was performed. RESULTS The median urine iodine concentration was 184 µg/l in school-age children. The prevalence of clinical hyperthyroidism, subclinical hyperthyroidism, clinical hypothyroidism and subclinical hypothyroidism was 0.97%, 1.95%, 0.90% and 5.55%, respectively. The prevalence of thyroid autoantibodies and thyroid nodules was 15.82% and 16.87%, respectively. The prevalence of clinical hyper- and hypothyroidism was greater in females than in males (P < 0.05). The prevalence of subclinical hyper- and hypothyroidism, thyroid nodules and thyroid autoantibodies increased significantly with age (P < 0.05). The rate of new abnormal TSH was 9.37%, and the average serum Thyroid Stimulating Hormone (TSH) concentrations increased with age. When TSH >0.71 mU/l, the prevalence of positive TPOAb and/or TgAb increased significantly with rising concentrations of TSH (P < 0.05); however, the prevalence of thyroid nodules did not increase with escalating concentrations of TSH (P = 0.09). CONCLUSION Subclinical thyroid diseases, especially subclinical hypothyroidism and thyroid nodules, are common in an iodine sufficient area. Females and the elderly might benefit from routine screening for thyroid diseases, followed by appropriate detection and treatment.
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Affiliation(s)
- Y R Yan
- From the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China, Department of Geriatrics Medicine of Sichuan Provincial People's Hospital, Chengdu, Sichuan 610041, China and Department of General Medicine, Yulin Community Health Service Center, Wuhou District, Chengdu, Sichuan 610041, China
| | - Y Liu
- From the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China, Department of Geriatrics Medicine of Sichuan Provincial People's Hospital, Chengdu, Sichuan 610041, China and Department of General Medicine, Yulin Community Health Service Center, Wuhou District, Chengdu, Sichuan 610041, China From the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China, Department of Geriatrics Medicine of Sichuan Provincial People's Hospital, Chengdu, Sichuan 610041, China and Department of General Medicine, Yulin Community Health Service Center, Wuhou District, Chengdu, Sichuan 610041, China
| | - H Huang
- From the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China, Department of Geriatrics Medicine of Sichuan Provincial People's Hospital, Chengdu, Sichuan 610041, China and Department of General Medicine, Yulin Community Health Service Center, Wuhou District, Chengdu, Sichuan 610041, China
| | - Q G Lv
- From the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China, Department of Geriatrics Medicine of Sichuan Provincial People's Hospital, Chengdu, Sichuan 610041, China and Department of General Medicine, Yulin Community Health Service Center, Wuhou District, Chengdu, Sichuan 610041, China
| | - X L Gao
- From the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China, Department of Geriatrics Medicine of Sichuan Provincial People's Hospital, Chengdu, Sichuan 610041, China and Department of General Medicine, Yulin Community Health Service Center, Wuhou District, Chengdu, Sichuan 610041, China
| | - J Jiang
- From the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China, Department of Geriatrics Medicine of Sichuan Provincial People's Hospital, Chengdu, Sichuan 610041, China and Department of General Medicine, Yulin Community Health Service Center, Wuhou District, Chengdu, Sichuan 610041, China
| | - N W Tong
- From the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China, Department of Geriatrics Medicine of Sichuan Provincial People's Hospital, Chengdu, Sichuan 610041, China and Department of General Medicine, Yulin Community Health Service Center, Wuhou District, Chengdu, Sichuan 610041, China
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