Çocukluk Çağında Portal Hipertansiyon: İki Merkez Deneyimi ve Literatür İncelemesi

Yıl 2015, , 177 - 182, 01.12.2015

Yeliz Çağan Appak , Fatih Ünal Erhun Kasırga

https://doi.org/10.4274/jcp.84856

Öz

Giriş: Bu çalışmada portal hipertansiyon PHT nedeni ile izlediğimiz hastalarımızın değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: 2005-2013 yılları arasında izlenen toplam 21 PHT’li hasta retrospektif olarak demografik verileri, başvuru nedenleri ve uygulanan tedaviler açısından değerlendirilmiştir.Bulgular: Çalışmaya alınan hastaların ortalama yaşı 9,3±5,3 yıl olup, %38,1’i kız, %61,9’u erkek idi. Hastaların %28,6’sının gastrointestinal sistem GİS kanaması, %14,3’ünün karında şişlik, %28,6’sının splenomegali, %9,5’inin hepatosplenomegali ve %19’unun karaciğer fonksiyon testlerinde yükseklik nedeni ile başvuru sonrası PHT tanısı aldığı görüldü. Ortalama tanı yaşı 6,8±4,7 yıl, ortalama izlem süresi 3,4±1,7 yıl idi. Üst GİS endoskopisinde hastaların %85,7’sinde özofagus varisleri saptanmış, bir hasta dışında tüm hastalara beta bloker tedavi başlanmıştır. Hastaların izlemleri süresince %52,4’ünde PHT sekonder GİS kanaması görülmüştür. Hastaların %4,8’ine skleroterapi, %19’una bant ligasyonu, %23,8’ine bant ligasyonu ve skleroterapi beraber uygulanmıştır. Bir hastaya rex şantı ve iki hastaya distal splenorenal şant yapılmıştır.Sonuç: PHT takibinde varis kanaması en önemli komplikasyondur. Hastalarda erken tanı ile medikal, endoskopik ve cerrahi önlemlerin alınması sonucu portal hipertansiyon komplikasyonları engellenebilir

Anahtar Kelimeler

Portal hipertansiyon, özofagus varisi, skleroterapi, bant ligasyonu

Portal Hypertension in Childhood: Two Centers Experience and Literature Review

Öz

Introduction: In this study, our objective is to make an assessment of the patients whom we have followed with portal hypertension.Materials and Methods: A total of 21 portal hypertension patients, followed between 2005 and 2013, were evaluated retrospectively with regards to demographic data, complaints leading to their application and treatments they received.Results: The average age of the patients was 9.3±5.3, 38.1% of the patients were female and 61.9% were male. Of the patients, 28.6% received portal hypertension diagnosis due to gastrointestinal system bleeding, 14.3% due to abdominal distention, 28.6% due to splenomegaly, 9.5% due to hepatosplenomegaly and 19% due to elevated liver function tests. The average age of receiving the diagnosis was 6.8±4.7 and duration of the follow-up was 3.4±1.7 years. Of the patients, 85.7% had esophageal varices according to the upper gastrointestinal system endoscopy and beta-blocker therapy was applied to all patients except for one. The follow-up of the patients revealed that 52.4% of them had gastrointestinal bleeding secondary to portal hypertension. The patients received sclerotherapy 4.8% , band ligation

Anahtar Kelimeler

Portal hypertension, esophageal varices, sclerotherapy, band ligation

Kaynakça

• 1. Vargas HE, Gerber D, Abu-Elmagd K. Management of portal hypertension-related bleeding. Surg Clin North Am 1999;79:1- 22.
• 2. Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology 2004;40:652-9.
• 3. Gugig R, Rosenthal P. Management of portal hypertension in children. World J Gastroenterol 2012;18:1176-84.
• 4. Mileti E, Rosenthal P. Management of portal hypertension in children. Curr Gastroenterol Rep 2011;13:10-6.
• 5. Soyupak S, Gunesli A, Seydaoğlu G, Binokay F, Celiktas M, Inal M. Portal venous diameter in children: Normal limits according to age, weight and height. Eur J Radiol 2010;75:245-7.
• 6. McKiernan PJ, Sharif K, Gupte GL. The role of endoscopic ultrasound for evaluating portal hypertension in children being assessed for intestinal transplantation. Transplantation 2008;86:1470-3.
• 7. Cales P, Zabotto B, Meskens C, Caucanas JP, Vinel JP, Desmorat H, et al. Gastroesophageal endoscopic features in cirrhosis. Observer variability, interassociations, and relationship to hepatic dysfunction. Gastroenterology 1990;98:156-62.
• 8. Tuggle DW, Bennett KG, Scott J, Tunell WP. Intravenous vasopressin and gastrointestinal hemorrhage in children. J Pediatr Surg 1988;23:627-9.
• 9. Tauber MT, Harris AG, Rochiccioli P. Clinical use of the long acting somatostatin analogue octreotide in pediatrics. Eur J Pediatr 1994;153:304-10.
• 10. Eroglu Y, Emerick KM, Whitington PF, Alonso EM. Octreotide therapy for control of acute gastrointestinal bleeding in children. J Pediatr Gastroenterol Nutr 2004;38:41-7.
• 11. Shashidhar H, Langhans N, Grand RJ. Propranolol in prevention of portal hypertensive hemorrhage in children: A pilot study. J Pediatr Gastronterol Nutr 1999;29:12-7.
• 12. Ozsoylu S, Koçak N, Demir H, Yüce A, Gürakan F, Ozen H. Propranolol for primary and secondary prophylaxis of variceal bleeding in children with cirrhosis. Turk J Pediatr 2000;42:31- 3.
• 13. Giouleme O, Theocharidou E. Management of portal hypertension in children with portal vein thrombosis. J Pediatr Gastroenterol Nutr 2013;57:419-25.
• 14. Molleston JP. Variceal Bleeding in Children. J Pediatr Gastroenterol Nutr 2003;37:538-45.
• 15. Fortune B, Garcia-Tsao G. Current Management Strategies for Acute Esophageal Variceal Hemorrhage. Curr Hepatol Rep 2014;13:35-42.
• 16. Goncalves ME, Cardoso SR, Maksoud JG. Prophylactic sclerotherapy in children with esophageal varices: Long-term results of a controlled prospective randomized trial. J Pediatr Surg 2000;35:401-5.
• 17. Hou MC, Lin HC, Kuo BI, Chen CH, Lee FY, Lee SD. Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: A prospective randomized trial. Hepatology 1995;21:1517-22.
• 18. Celinska-Cedro D, Teisseyre M, Woynarowski M, Socha P, Socha J, Ryzko J. Endoscopic ligation of esophageal varices for prophylaxis of first bleeding in children and adolescents with portal hypertension: Preliminary results of a prospective study. J Pediatr Surg 2003;38:1008-11.
• 19. Moon SB, Jung SE, Ha JW, Park KW, Seo JK, Kim WK. The usefulness of distal splenorenal shunt in children with portal hypertension for the treatment of severe thrombocytopenia and leukopenia. World J Surg 2008;32:483-7.
• 20. Krebs-Schmitt D, Briem-Richter A, Grabhorn E, Burdelski M, Helmke K, Broering DC, et al. Effectiveness of Rex shunt in children with portal hypertension following liver transplantation or with primary portal hypertension. Pediatr Transplant 2009;13:540-54.