成人门静脉海绵样变63例的诊断与外科治疗  

Diagnosis and surgical treatment of adult cavernous transformation of portal vein in 63 cases

作　　者：杨维良[1] 闫朝岐[1] 张好刚[1] 马玉林[1] 王夫景[1] 迟强[1] 杨学伟[1] 

机构地区：[1]哈尔滨医科大学附属第二医院普外科,150086

出　　处：《中华肝胆外科杂志》2010年第2期115-118,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的总结成人门静脉海绵样变（cavernous transformation of portal vein, CTPV））的诊断与外科治疗经验。方法回顾性分析1976年至2006年成人CTPV63例临床资料。结果成人CTPV的诊断依据：（1）脾脏肿大、脾功能亢进症状，半数以上病例并发上消化道出血、中等或小量腹水，肝脏无肿大、肝功能基本正常。（2）彩色Dopple超声检查显示门静脉内径变细、闭塞或栓塞，肝门部向肝血流紊乱并呈“蜂窝状”，管道内为红蓝相间的血流信号。（3）CT及MRI显示门静脉阻塞或狭窄及发现侧支循环形成，边缘呈波浪状。（4）肠系膜上动脉及腹腔动脉造影静脉期门静脉主干未显影，肝门区广泛迂曲，呈团块状血管影。成人CTPV的治疗：63例均行手术治疗其中脾切除、门奇静脉断流术23例；脾切除、远端脾肾静脉分流术32例；门奇静脉断流术联合分流术8例。CTPV合并胆道疾病宜先处理门静脉高压症。该组无手术病死病例，术后近期血常规及血小板计数均恢复正常。结论CTPV一旦确定诊断并有手术适应证，就应积极手术治疗；选择合适的术式是手术成功的关键。Objective To summarize the transformation of portal vein （CTPV）. Methods diagnosis and surgical treatment of the cavernous Clinical data of 63 patients with adult CTPV trea- ted in our hospital from 1976 to 2006 were retrospectively analyzed. Results The diagnosis of CT PV was comfirmed according to （1） The main symptoms were repeated haematemesis, hemafecia, hy- persplenotrophy, hypersplenia and normal hepatic function. （2） B ultrasonography or ultrasonic Doppler manifested that portal vein thinning or obstruction or embolism, honeycomb appearance con duit can be seen around. Portal vein frequency spectrum can be seen in the honeycomb appearance con- duit. （3） CT and MR scan materials were exhibited that the main portal vein and its branches lost the normal shape and had the shaggy edge. （4） percutaneous splenoportography or selective arteriography of superior mesenteric artery showed that occlusion of the main branch of portal vein at the porta hepa- tis was revealed, and a masslike network of tortuose veins around the porta hepatis and many small ir- regular veins radiating f rom the network to the liver were demonst rated. Splenectomy and devascu- larization was performed in 23, splenectomy and splenorenal shunt in 32, portal systemic shunt plus porta-azygous devascularization in 8. Portal hypertension was treated first in CTPV with disease of biliary tract. No death happened. The rascult of haemogram recovered in a short period of time. Conclusion Once the patients are diagnosed to suffer from adult CTPV, they should receive explora- tory laparotomy. It is important to choose the most effective treating method for the disease.

关 键 词：门静脉海绵样变 诊断 外科治疗 

分 类 号：R654.3[医药卫生—外科学]