区域性门静脉高压症的诊断与治疗  

Diagnosis and Treatment of Regional Portal Hypertension

作　　者：陈中[1] 倪家连[1] 刘鲁岳[1] 郑宝珍[1] 刘晓明[1] 

机构地区：[1]济南军区总医院肝胆外科,山东济南250031

出　　处：《中国现代普通外科进展》2010年第8期624-626,共3页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:总结区域性门静脉高压症的临床、影像学特点以及治疗方法。方法:回顾性分析济南军区总医院1996年12月—2007年6月外科治疗的21例区域性门静脉高压症患者的临床表现、诊治及预后。结果:21例区域性门静脉高压症中,合并胰腺疾病16例,另5例无明确胰腺疾病。临床表现和原发病有关,上腹疼痛不适(以左上腹为主)12例(57%);呕血或黑便9例(43%),体检发现腹部肿块6例(29%),不明原因发热2例(10%);所有病例均有不同程度的脾脏肿大。2例HBsAg阳性(B型超声检查无肝硬化及门静脉高压症表现),其余病例均无肝炎病史,所有病例术前肝功能检查均在正常范围。合并脾功能亢进11例(52%)。所有病例均经外科手术治疗,术后随访3年,除1例术后发生上消化道出血经内镜治疗外,其余均未发生出血。结论:多普勒超声和内镜检查并结合临床特点,可以诊断区域性门静脉高压症。治疗上在积极治疗原发疾病的同时,根据术中探查胃底静脉曲张尤其是术前有上消化道出血病史者同时行脾切除加贲门周围血管离断术。Objective：To summarize the clinical data,imaging data and treatments of regional portal hypertension（RPH）.Methods：The clinical data of 16 patients with RPH treated in our department from December 1996 to June 2007 were retrospectively analyzed.Results：Among 21 patients with RPH,16 cases suffered from pancreatic diseases,and 5 cases were complicated with non-pancreatic diseases.There were 12 cases（57%）whose symptoms were abdominal pain and discomfort,gastrointestinal bleeding in 9 cases（43%）,abdominal masses in 6 cases（29%）,fever in 2 cases（10%）,splenomegaly in all 21cases（100%）and hypersplenism in 11 cases（52%）.No patients had the history of hepatitis except positive HBsAg in 2 patients.Preoperative laboratory examinations showed hepatic function normal in 21 patients.All patients underwent operations with no rehaemorrhagia within 3 years follow-up except 1 case.Conclusions：It is not difficult to diagnoseRPH with Doppler ultrasound,endoscopy and special clinical characteristics.Therapeutic options should be individualized according to exploration and primary diseases,splenectomy and should be performed in the patients with gastrointestinal bleeding.

关 键 词：门静脉高压症 胰腺炎 胃静脉曲张 脾脏切除 

分 类 号：R657.34[医药卫生—外科学]