ObjectiveTo summarize the clinical experience of retropancreatic tunnel established by superior mesenteric vein-approach in a child with cavernous transformation of the portal vein (CTPV) during Rex bypass. MethodThe retropancreatic tunnel was created by the superior mesenteric vein-approach during Rex bypass in a child with CTPV who was admitted to our hospital in September, 2023. Clinical data were retrospectively analyzed. ResultsFor the 4-year-old male child who was diagnosed with CTPV, after the establishment of the retropancreatic tunnel by superior mesenteric vein-approach, the portal vein was quickly identified, thus simplifying the portal dissection. The operation time of Rex bypass was about 8 hours, and intraoperative blood loss was about 60 mL. After a 3-month follow-up, the child recovered well with patent bypass vessels. ConclusionThe surgical strategy proposed by our team can simplify the Rex bypass, resulting in more rapid and safe access to the vascular anastomosis site.
ObjectiveTo sort out the key evidence-based medical evidence and research progress of cavernous transformation of the portal vein (CTPV) in recent years, summarize its diagnosis and treatment strategies, and provide guidance for clinical practice. MethodsThe key studies in the fields of etiological characteristics, clinical manifestations, imaging diagnostic techniques, surgical operations, interventional therapy, and medical conservative treatment of CTPV were reviewed, with a focus on the research results related to the multidisciplinary team (MDT) diagnosis and treatment model. ResultsThe diagnosis and treatment model of CTPV has shifted from traditional empirical treatment to precise diagnosis and treatment driven by etiology and imaging characteristics. Specifically, the rapid development of imaging technology has significantly improved the early diagnosis rate; the wide application of the MDT diagnosis and treatment model has optimized the scientificity of treatment decisions; the treatment plan needs to be individually selected according to the patient’s etiology, vascular anatomical conditions, and liver function classification, including surgical shunt/reconstruction, interventional therapy and medical symptomatic support treatment. ConclusionsCurrently, the diagnosis and treatment of CTPV have achieved precise improvement relying on the progress of imaging technology and the MDT model. Individualized comprehensive treatment can effectively improve the prognosis of patients. However, there are still many controversies in the definition of surgical indications, selection of treatment strategies, and optimization of long-term management plans. Further exploration is needed in the future to improve the diagnosis and treatment system.
