Treatment of portal hypertension in children.

摘要: The management of children with portal hypertension (PH) has substantially changed owing to the good results and broader application both endoscopic sclerotherapy orthotopic liver transplantation (OLT). Since introduction for treatment bleeding esophageal varices, number surgical procedures sharply decreased. Until early 1980s, however, choice varices was based on different variations two main types open surgery: devacularization transection operations portosystemic shunts. experience nonshunt is limited in pediatric population. Literature reports from last 25 years have emphasized a restrictions related shunts small subjects. However, shunts, selective or not, can be performed even very young subjects high rates success. From 1974 1984 distal splenorenal shunt (DSRS) procedure variceal our institution. Forty-two underwent DSRS during this period. 1985, when (EVS) replaced as first therapeutic option service, been only 8 whom EVS failed, none them 2 years. In cohort 50 cases DSRS, patency increased 71% 7 patients 95% thereafter. There no perioperative mortality. 1985 April 1993, 107 were submitted sessions bleeding. Among 62 patients, complete obliteration obtained 85%, incidence upper gastrointestinal (GI) hemorrhage before total 53%. next 45 children, such indexes 96% 18%, respectively, due shorter interval between applied group. Currently, we are conducting prospective, randomized, trial evaluate prophylactic value EVS: 49 received prophylaxis, 28 not (controls). statistically significant difference GI groups: 6% 7%. source each group, being always control group hemorrhagic gastritis prophylaxis conclusion: (1) safe highly effective PH children. It currently treatment; (2) still plays an important role failure; (3) Although prevent PH, it proved decrease up time; (4) OLT definitive end-stage disease, without previous shunt.