肝前性门静脉高压症:9年诊治经验  

Diagnosis and management for prehepatic portal hypertension:9 years experience

作　　者：吴继东[1] 汪忠镐[2] 王仕华[3] 刘昌伟[1] 曾嵘[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院血管外科中心,北京100032 [2]首都医科大学血管外科研究所,北京100053 [3]北京海军总医院血管外科,北京100037

出　　处：《临床肝胆病杂志》2011年第2期134-135,142,共3页Journal of Clinical Hepatology

摘　　要：目的探讨肝前性门脉高压综合征(PPH)诊断、临床特征、治疗方法的选择和疗效观察。方法回顾分析PPH40例患者的临床资料,依照间接门静脉造影和/或门静脉系统CT血管成像,全部确诊为PPH。施肠系膜上静脉-下腔静脉转流术31例,脾切除、脾静脉-肾静脉转流术4例,门静脉-下腔静脉转流术1例,肠系膜上静脉门静脉探查术、门奇静脉断流术2例,未行手术2例,仅给与保肝等内科治疗。结果 39例术后随访3个月～8年,1例未手术患者失访。36例经肠腔、脾肾和门腔转流手术治疗的患者术后脾亢消失,未再发生上消化道出血;2例断流手术患者,术后8月1例死亡,2例保守治疗1例死亡。结论间接门静脉系造影或CT门静脉系血管成像检查是诊断PPH的标准方法,分流手术安全有效。Objective To discuss the diagnosis,clinical features,and treatment for prehepatic portal hypertension and investigate the efficacy of surgery for this disease.Methods A retrospective analysis of 9 years experience of totally 40 cases of prehepatic portal hypertension was taken into account.All cases were diagnosed with indirect portal vein angiography and/or CTV of meso-portal vein.Surgical strategy included： 31 cases of mesocaval shunt;4 cases of splenectomy and spleno-renal vein shunt;1 case of porta-caval shunt;2 cases of esophagogastric vein excision and ligation with exploration of portal vein and inferior vena cave and another 2 cases had no-surgical option and underwent conservative treatment.Results Follow-up was performed in 39 cases ranging from 3 months to 8 years after operations.The patients without operation have not been followed up.Satisfactory outcomes were obtained from 36 cases with various portal-caval shunts,including disappearance of a syndrome of hypersplenism and no recurrence of gastrointestinal hemorrhage.On the other hand,2 cases treated without shunt were dead within 8 months of follow-up and one of the two cases with conservative treatment was dead either.Conclusion Portovenography and/or CTV is a standard diagnosis method for pre-hepatic portal hypertension.Surgical management of portacaval shunt is a good choice for pre-hepatic portal hypertension.

关 键 词：高血压 门静脉 门体分流术 外科 

分 类 号：R657.34[医药卫生—外科学]