胰源性门静脉高压症21例的诊治经验  

Experience in Diagnosis and Treatment of Pancreatogenic Portal Hypertension:An Analysis of 21 Cases

作　　者：王烈[1] 王瑜[1] 姚和祥[1] 陈少全[1] 邹忠东[1] 

机构地区：[1]福州总医院南京军区普通外科研究所

出　　处：《福州总医院学报》2010年第1期10-12,共3页Journal of Fuzhou General Hospital

基　　金：福建省自然科学基金(2006J0372)资助

摘　　要：目的:探讨胰源性门静脉高压症的诊断方法和治疗措施。方法:回顾分析我院自1995年3月至2006年6月收治的胰源性门静脉高症症21例,均有胰腺炎病史,其中3例合并假性囊肿,1例合并胰尾部癌。10例有上消化道大出血。结果:16例行手术治疗。手术指征:胃底静脉重度曲张或伴有食道静脉曲张,既往有上消化道大出血史,以及门静脉主干有血栓形成。手术方法:脾切除是基本方法,胰周纤维化明显者联合胰体尾切除;假性囊肿行囊肿-空肠Roux-en-y式吻合;胰尾癌行胰体尾切除;有食道静脉曲张者附加贲门食道周围血管离断术;门静脉主干有血栓者行肠系膜上静脉—下腔静脉H型分流术。5例行非手术治疗。结论:胰源性门静脉高压症,临床较为少见,其诊断和治疗有不同于肝硬化性门脉高压的特点。手术效果良好。对于胃底静脉曲张较轻,无出血史者可非手术治疗,随着胰腺原发病的控制和血栓再通,胃底静脉曲张也可好转或停止发展。Objective： To explore the diagnosis and treatment of pancreatogenic portal Hypertension. Method： 21 patients with pancreatogenic portal hypertension were reviewed from March 1995 to June 2006, 3 patients of which complicated pancreatic pseudocyst, 1 patient complicated pancreatic carcinoma, 10 patients complicated upper gastrointestinal bleeding due to panereatogenie portal hypertension. Results： Surgery was performed in 16 patients due to the history of upper gastrointestinal bleeding, severe gastric varices or with esophageal varices and thrombosis of portal vein. Splenectomy was a essential treatment, and distal pan- createctomy should be performed when found pancreatic fibrosis. Roux - en - y cystojejunostomy was performed in 3 patients with pancreatic pscudocysts, the resection of pancreatic carcinoma in 1 patient. Peri - esophgeal vascular severance （Hassab＇ s operation） was performed in the patients of esophageal varices. Potocaval H - graft was performed in 3 patients with thrombosis of port.al vein . The treatment of 5 patients was conservative. All the patients were followed up for 1 - 6 years and recoved nice after the treatment. Conclusion： Pancreatogenic portal hypertension is seen little clinically. The diagnosis and treatment are of particular as compared with portal hypertension in patients with cirrhosis of liver. The indications of surgery with pancreatogenic portal hypertension are the history of upper gastrointestinal bleeding, severe gastric varices or with esophageal varices and thrombsis of portal vein. The medical treatment is selected for mild gastric variaces.

关 键 词：慢性胰腺炎 门静脉高压 脾切除术 

分 类 号：R657.34[医药卫生—外科学]