Russian Journal of Pediatric SurgeryRussian Journal of Pediatric SurgeryДетская хирургия1560-95102412-0677Eco-Vector70210.17816/ps702Case reportsКлинические случаиResearch ArticleMeso-Rex bypass in a 7-month-old child with prehepatic portal hypertensionМезопортальное шунтирование у ребёнка 7-ми мес. с предпечёночной портальной гипертензиейhttps://orcid.org/0000-0003-4379-80518803-6595ZadvernyukAleksandr S.ЗадвернюкАлександр Сергеевич
Russian Federation

MD, Cand. Sci. (Medicine)

кандидат медицинских наук

drsasha81@yandex.ruhttps://orcid.org/0000-0003-0834-26304687-1558KulikovaNadezhda V.КуликоваНадежда Владимировна
Russian Federation

MD, Cand. Sci. (Medicine)

кандидат медицинских наук

dr.kulikovan.v@gmail.comhttps://orcid.org/0009-0002-6025-13571431-2990NurikVera I.НурикВера Исааковна
Russian Federation

MD, Cand. Sci. (Medicine)

кандидат медицинских наук

vera.nurik@mail.ruhttps://orcid.org/0000-0002-9497-40703600-4701RazumovskiyAleksander Yu.РазумовскийАлександр Юрьевич
Russian Federation

MD, Dr. Sci. (Medicine), Professor

доктор медицинских наук, профессор

1595105@mail.ruhttps://orcid.org/0009-0004-0771-69228851-7247KnyazevaNatalia A.КнязеваНаталия Александровна
Russian Federation
nata-knya@yandex.ruThe Russian National Research Medical University named after N.I. PirogovРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаFilatov N.F. Children's City HospitalДетская городская клиническая больница имени Н.Ф. Филатова28042024300520242822242302906202308092023Copyright ©; 2024, Zadvernyuk A.S., Kulikova N.V., Nurik V.I., Razumovskiy A.Y., Knyazeva N.A.Copyright ©; 2024, Задвернюк А.С., Куликова Н.В., Нурик В.И., Разумовский А.Ю., Князева Н.А.2024Zadvernyuk A.S., Kulikova N.V., Nurik V.I., Razumovskiy A.Y., Knyazeva N.A.Задвернюк А.С., Куликова Н.В., Нурик В.И., Разумовский А.Ю., Князева Н.А.https://jps-nmp.ru/jour/article/view/702

BACKGROUND: The prehepatic form of portal hypertension is the most common cause of portal hypertension in children. Nowadays mesoportal shunting is the most optimal therapy for such pathology. In the world literature, there are only few publications describing application of such surgical technique in children of the first year of life.

CLINICAL CASE DESCRIPTION: The article describes a case of a 7-month old child with prehepatic portal hypertension who had mesoportal bypass surgery. A month before the surgery, the child had an episode of gastrointestinal bleeding which was treated conservatively. Additional diagnostics before surgery included liver and spleen ultrasound examination, transarterial mesenteric portography, and esophagogastroduodenoscopy. The child was discharged home on the 6th postoperative day. For three months after the surgery, he received antiplatelet therapy and proton pump inhibitors. In 3-months, follow-up ultrasound showed satisfactory blood flow through the shunt. Patient’s weight gain had also a positive trend.

CONCLUSION: Mesoportal bypass surgery is technically achievable in children of the first year of life. In our opinion, patient’s age has a positive impact on creating a functioning mesoportal shunt: the younger the patient, the greater the likelihood of favorable outcome.

Обоснование. Предпечёночная форма портальной гипертензии — самая частая причина портальной гипертензии у детей. Оптимальным методом лечения данной патологии у детей в настоящее время является мезопортальное шунтирование. В мировой литературе описано мало наблюдений за детьми первого года жизни, которым была бы проведена данная операция.

Описание клинического случая. В статье приведено описание лечения пациентки с предпечёночной формой портальной гипертензии, которой было выполнено мезопортальное шунтирование в возрасте 7-ми мес. За месяц до проведения оперативного лечения у ребёнка зафиксирован эпизод желудочно-кишечного кровотечения, который удалось купировать консервативно. Дообследование перед операцией включало ультразвуковое исследование печени и селезёнки, трансартериальную мезентерикопортографию, эзофагогастродуоденоскопию. Ребёнок был выписан домой на 6-е послеоперационные сут, в течение 3 мес. после операции получал антиагрегантную терапию и ингибиторы протонной помпы. При контрольном осмотре спустя 3 мес. после операции по результатам ультразвукового исследования наблюдался удовлетворительный кровоток по шунту. Также отмечалась положительная динамика относительно прибавок массы тела пациента.

Заключение. Проведение мезопортального шунтирования технически возможно у детей первого года жизни. По нашему мнению, возраст пациента коррелирует с вероятностью создания функционирующего мезопортального шунта: чем младше пациент, тем больше вероятность благоприятного исхода операции.

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