Correlation between intraoperative portal venous pressure changes and prognosis of Rex shunt
10.3760/cma.j.cn113884-20240830-00265
- VernacularTitle:术中门静脉压力变化与Rex手术预后的相关性研究
- Author:
Fuyu YOU
1
;
Jieqin WANG
1
;
Zhe WEN
1
Author Information
1. 广州医科大学附属妇女儿童医疗中心小儿外科，广州 510623
- Publication Type:Journal Article
- Keywords:
Portal pressure;
Extrahepatic portal venous obstruction;
Rex shunt;
Portal vein pressure gradient;
Prognosis
- From:
Chinese Journal of Hepatobiliary Surgery
2025;31(6):438-442
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the relationship between intraoperative portal venous pressure gradient (PVPG) changes and clinical outcomes of meso-Rex bypass in pediatric patients with extrahepatic portal vein obstruction (EHPVO).Methods:Clinical data of 76 children with EHPVO undergoing Rex shunt at Guangzhou Women and Children’s Medical Center, Affiliated to Guangzhou Medical University from April 2018 to October 2021 were retrospectively analyzed, including 49 males and 27 females, aged 62.0 (42.0, 102.5) months. Logistic regression was used to identify prognostic factors. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of PVPG variations. The association between pre-/postoperative PVPG differences and clinical outcomes (resolution of hypersplenism/splenomegaly, improvement of gastroesophageal varices, and vascular complications) were systematically assessed.Results:All 76 pediatric patients underwent the Rex shunt successfully. Postoperative vascular complications occurred in 14 cases (18.4%), including six cases of bypass graft thrombosis (7.9%) and eight cases of anastomotic stenosis (10.5%). Logistic regression analyses revealed that graft type ( OR=0.03, 95% CI: 0-0.30, P=0.003) and PVPG gradient ( OR=1.65, 95% CI: 1.07-2.53, P=0.022) were associated with esophagogastric varices resolution after Rex shunt. Graft type also correlated with splenomegaly/hypersplenism improvement ( OR=0.08, 95% CI: 0.01-0.80, P=0.032). PVPG gradient showed association with anastomotic stenosis ( OR=0.69, 95% CI: 0.51-0.93, P=0.014). The area under ROC curves of PVPG gradient are 0.786 and 0.815 for predicting varices resolution and anastomotic stenosis, respectively. Conclusion:An increased intraoperative PVPG gradient could serve as a protective factor for an improved outcome of Rex shunt in EHPVO children and reduced risk of anastomotic stenosis.
