肝前型门静脉高压症的诊治  

Diagnosis and Treatment of Prehepatic Portal Hypertension

作　　者：李震[1] 吴继东[2] 汪忠镐[1,3] 卞策[4] 侯高峰[4] 霍小森[1] 王雷永[1] 

机构地区：[1]中国航空工业中心医院血管外科,北京100012 [2]中国医学科学院中国协和医学院北京协和医院血管外科中心,北京100730 [3]首都医科大学血管外科研究所,北京100053 [4]第二炮兵总医院血管外科,北京100088

出　　处：《中国普外基础与临床杂志》2009年第12期1005-1009,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨肝前型门静脉高压症的临床特点、诊断、治疗方法的选择及疗效。方法回顾性分析第二炮兵总医院及北京协和医院2000年1月至2009年5月期间收治的46例肝前型门静脉高压症(包括2例Abern-ethy畸形)患者的临床资料。全部患者均根据间接门静脉造影、CT血管造影和(或)彩超检查结果确诊为肝前型门静脉高压症。行肠系膜上静脉-下腔静脉分流术23例;脾切除、脾静脉-肾静脉分流术8例;门静脉-下腔静脉分流术1例;附脐静脉-颈内静脉分流术2例;门奇静脉断流术3例;脾切除、门奇静脉断流术1例;乙状结肠暂时性造瘘,6个月后闭瘘1例;大部分小肠切除术1例;经股动脉插管溶栓4例;未行手术2例,仅给予护肝及对症治疗。结果44例患者随访2个月～5年,平均23.4个月,1例未手术者失访。34例行分流手术治疗的患者术后脾功能亢进症状消失,未再发生上消化道出血;行断流术者术后13个月及2年因再次出血行肠系膜上静脉-下腔静脉分流术2例;断流术后8个月因再次出血死亡1例;溶栓治疗后40d因肠坏死死亡1例,1例未手术的患儿出院4个月后再次出现黑便经保守治疗好转。结论肝前型门静脉高压症的治疗以降低门静脉压力为主,各种分流手术及肠系膜上动脉和(或)脾动脉置管溶栓安全有效,但需根据个体情况施行。Objective To explore the clinical presentation and diagnosis and treatment of prehepatic portal hypertension （PPH） and discuss its surgical strategies.Methods Forty-six cases of PPH treated in the 2nd Artillery General Hospital and Peking Union Medical College Hospital from January 2000 to May 2009 were analyzed retrospectively,including 2 cases of Abernethy abnormality.All patients were evaluated by indirect portal vein angiography,CT angiography and （or） portal duplex system Doppler ultrasonography before treament. Surgical strategies included= 23 cases with meso-caval shunt, 8 cases with splenectomy and spleno-renal vein shunt, 1 case with porta caval shunt, 2 cases with paraumbilical vein jugular vein shunt, 3 cases with portal azygous disconnection, 1 cases with splenectomy and portal azygous disconnection, 1 case with sigmoidostomy and closed the fistula of sigmoid six months later, 1 case with resection of part of small intestine due to acute extensive thrombosis of portal vein system, 4 cases with selective superior mesenteric artery and （or） splenic artery thromholytic infusion therapy, 2 cases re mained no-surgical option and underwent conservative treatment. Results Fort^four patients were followed-up from 2 months to 5 years, average of 23.4 months, one patient without surgical treatment was lost. Satisfactory outcomes were obtained in 34 patients with various shunts, which expressed as a release of hypersplenism and gas- trointestinal hemorrhage. Two cases were treated with meso-caval shunt because of rehemorrhage in month 13 and 24 and one died in month 8 after disconnection, one died on day 40 after thrombolytic therapy due to putrescence of intestines, one who remained no-surgical option underwent hemorrhage 4 months later, and then went well by conservative treatment. Conclusion The key of treatment of PPH is to reduce the pressure of hepatic portal vein. Surgical managements of shunt and selective superior mesenteric artery and （or） splenic artery thrombolytic infusion therapy ar

关 键 词：肝前型门静脉高压症 ABERNETHY畸形 附脐静脉 分流术 溶栓 

分 类 号：R657.3[医药卫生—外科学]