门静脉海绵样变的临床诊治  

The Diagnosis and Treatment of Cavernous Transformation of Portal Vein

作　　者：信明军[1] 王占春[1] 于江[1] 类成刚[1] 许评[1] 

机构地区：[1]青岛市市立医院肝胆外科,山东青岛266071

出　　处：《临床普外科电子杂志》2013年第2期40-43,共4页Journal of General Surgery for Clinicians(Electronic Version)

摘　　要：目的：探讨门静脉海绵样变的临床诊断和治疗方法。方法回顾性分析近年我院收治的5例门静脉海绵样变患者的临床资料并结合文献进行讨论。结果5例均经彩色多普勒超声及/或腹部强化CT检查确诊。1例因反复上消化道大出血急诊行脾切除+贲门周围血管离断术，1例既往已行脾切除加断流术后再出血者再次断流后行限制性肠系膜上静脉-下腔静脉分流术，2例行脾切除加贲门周围血管离断联合脾肾静脉分流术。1例上消化道出血经非手术治疗好转后放弃手术。5例患者随访1~6年，除1例行脾切除加贲门周围血管离断术后再次复发出血外，其余患者术后情况均稳定。结论彩色多普勒超声是门静脉海绵样变的首选诊断方法；脾切除加断流联合分流术是门静脉海绵样变的首选术式，但需具体病人具体分析。Objective:To investigate the clinical diagnosis and treatment of cavernous transformation of portal vein. Methods A retrospective analysis was made for 5 cases of cavernous transformation of portal vein in our hospital and clinical data and the literature on cavernous transformation of portal vein at home and abroad were discussed and reviewed. Results 5 patients were diagnosed by color Doppler ultrasound and /or abdominal enhanced CT scan examination,of which 1 patient underwent emergency splenectomy with pericardial devascularization due to recurrent hemorrhage in upper digestive tract,1 patient with rebleeding after operation on splenectomy with pericardial devascularization underwent restricted shunt between superior mesenteric vein and inferior vena cava,2 underwent splenectomy with pericardial devascularization combined with shunt between splenic vein and renal vein and 1 with upper digestive tract hemorrhage recovered through non-operative therapy without undergoing operation.All 5 patients were followed up for 1 to 6 years. All patients have good condition except 1 with recurrent hemorrhage in upper digestive tract after splenectomy with pericardial devascularization.Conclusion Color Doppler ultrasound is the first choice of method for the diagnosis of cavernous transformation of portal vein and splenectomy with pericardial devascularization combined with shunt between portal vein system and vena cava system is the first choice of treatment for this disease.It is also very important to performe individualized operative therapy for the patients with cavernous transformation of portal vein.

关 键 词：门脉高压症 门静脉海绵样变 诊断 治疗 

分 类 号：R81[医药卫生—放射医学] R65[医药卫生—临床医学]