Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector131110.17816/psaic1311ReviewsОбзорыReview ArticleVascular bypass surgery in the treatment of extrahepatic portal hypertension in children (review)Операции сосудистого шунтирования в лечении детей с внепеченочной портальной гипертензией (обзор литературы)https://orcid.org/0000-0002-0016-64445182-1748MitupovZorikto B.МитуповЗорикто Батоевич
Russian Federation

Dr. Sci. (Med.), professor

д-р мед. наук, профессор

zmitupov@mail.ruhttps://orcid.org/0000-0003-3511-04563600-4701RazumovskyAleksander Yu.РазумовскийАлександр Юрьевич
Russian Federation

Dr. Sci. (Med.), corresponding member of the Russian Academy of Sciences, professor

д-р мед. наук, чл.-корр. РАН, профессор

1595105@mail.ruhttps://orcid.org/0000-0002-1304-05929371-5492RachkovViktor E.РачковВиктор Евгеньевич
Russian Federation

Dr. Sci. (Med.), professor

д-р мед. наук, профессор

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

pediatric surgeon

врач-хирург детский

dr.kulikovan.v@gmail.comhttps://orcid.org/0000-0002-9968-2931MargaryanSergey R.МаргарянСергей Рубенович
Russian Federation

postgraduate student

аспирант

sergey.margaryan27@mail.ruPirogov Russian National Research Medical UniversityРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаFilatov Children’s HospitalДетская городская клиническая больница им. Н.Ф. ФилатоваClinical Hospital “Lapino-1”Клинический госпиталь «Лапино-1»280220231005202313137521212202221022023Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-Вектор2023Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/1311

In children with extrahepatic portal hypertension (EPHT), the most frequent and life-threatening complication is bleeding from varicose veins of the esophagus and stomach. Therefore, the main task of HSV treatment is to prevent bleeding from the veins of the upper gastrointestinal tract. The most effective treatment is portosystemic bypass surgery, with effectiveness of 94%–97%. However, the use of these operations is limited precisely by a decrease in portal liver perfusion and development of portosystemic encephalopathy. This study aimed to analyze domestic and foreign publications devoted to the surgical treatment of portal hypertension and the development of portosystemic encephalopathy during the postoperative period. A systematic search was carried out in PubMed, Web of Science, Scopus, MEDLINE, eLibrary, RSCI, and Cyberleninka; 345 references were analyzed, 110 articles were reviewed, and 97 publications on the surgical treatment of portal hypertension were selected for the review. The development of portosystemic encephalopathy during the postoperative period often occurs after the imposition of total portosystemic bypass surgery. To reduce the risk of developing portosystemic encephalopathy, selective shunts have been developed, which to some extent preserve the PPP. With distal splenorenal anastomosis, the frequency of portosystemic encephalopathy is 10%–15%. An intermediate position is occupied by a side-to-side splenorenal anastomosis, which has signs of selective surgery. The results of the analysis of literature sources showed that discussions are still underway regarding the choice of the optimal treatment strategy for patients with EPHT, place and role of endoscopic methods for the prevention of gastrointestinal bleeding, and mesoportal shunt in the treatment of patients with EPHT. Nevertheless, the majority of world experts consider mesoportal shunt to be the most optimal operation for the primary and secondary prevention of varicose bleeding and other HSV complications. If it is impossible to perform, selective bypass surgery of the distal splenorenal anastomosis can be an alternative to a mesoportal shunt.

У детей с внепеченочной портальной гипертензией самым частым и опасным для жизни осложнением является кровотечение из варикозно расширенных вен пищевода и желудка. Поэтому основная задача лечения внепеченочной портальной гипертензии — предотвращение кровотечений из вен верхних отделов желудочно-кишечного тракта. Наиболее эффективным лечением можно считать операции портосистемного шунтирования, эффективность которых достигает 94–97 %. Тем не менее применение этих операций ограничено именно из-за снижения портальной перфузии печени и развития портосистемной энцефалопатии. Цель исследования — проанализировать отечественные и зарубежные публикации, посвященные хирургическому лечению портальной гипертензии и развитию портосистемной энцефалопатии в послеоперационном периоде. Систематический поиск проведен в базах данных PubMed, Web of Science, Scopus, MEDLINE, eLibrary, РИНЦ, Cyberleninka. Анализу подвергнуты 345 ссылок, просмотрено 110 статей, отобрано 97 публикаций по хирургическому лечению портальной гипертензии. Развитие в послеоперационном периоде портосистемной энцефалопатии часто возникает после наложения тотальных портосистемных шунтов. Для снижения риска развития портосистемной энцефалопатии были разработаны селективные шунты, которые в той или иной степени сохраняют портальную перфузию печени. При дистальном спленоренальном анастомозе частота портальной перфузии составляет менее 10–15 %. Промежуточное положение занимает спленоренальный анастомоз бок-в-бок, который обладает признаками селективной операции. Результаты анализа источников литературы показали, что до сих пор ведутся дискуссии относительно выбора оптимальной стратегии лечения пациентов с внепеченочной портальной гипертензией, места и роли эндоскопических методов профилактики кровотечений желудочно-кишечного тракта, а также мезопортального шунта при лечении пациентов с внепеченочной портальной гипертензией. Тем не менее большинство мировых экспертов считают наложение мезопортального шунта наиболее оптимальной операцией для первичной и вторичной профилактики варикозного кровотечения и других осложнений внепеченочной портальной гипертензии. А при невозможности ее выполнения операция селективого шунтирования — дистального спленоренального анастомоза — может служить альтернативой выполнению мезопортального шунта.

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