胰源性门静脉高压症合并脾肿大的诊治分析  

Diagnosis and treatment of pancreatic sinistral portal hypertension with splenomegaly

作　　者：李晓斌[1] 廖泉[1] 丛林[1] 徐强[1] 宋一民[1] 赵玉沛[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院基本外科,北京100730

出　　处：《中华肝胆外科杂志》2013年第11期827-830,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：卫生行业科研专项项目（201002015）;首都医学发展科研基金（2009-1001）

摘　　要：目的探讨胰源性门静脉高压症合并脾肿大的诊断和治疗方法。方法回顾分析2010年1月至2012年12月诊治的26例胰源性门静脉高压症合并脾肿大患者的诊疗和随访资料。结果26例患者中，慢性胰腺炎12例（46％），胰腺假性囊肿5例（19％），胰腺体尾部肿瘤6例（23％），自身免疫性胰腺炎2例（8％），胰腺外伤1例（4％）。26例均有脾肿大，均无肝硬化和肝功能异常表现，其中3例有上消化道出血史。胃镜或上消化道造影提示26例患者均有胃底静脉曲张，6例合并食管下段静脉曲张。19例行手术治疗，2例行脾动脉栓塞治疗，5例保守治疗。22例患者获得随访，随访率为85％，随访6～30个月。随访期间患者未出现上消化道出血，手术后患者脾功能亢进消失，2例患者死于胰腺恶性肿瘤。结论脾肿大是胰源性门静脉高压症特征性临床表现之一。该病手术治疗效果确切，应根据病例特点选择不同的治疗方法。同时，应重视对胰腺原发疾病的治疗。Objective To study the diagnosis and treatment of pancreatic sinistral portal hyper- tension with splenomegaly. Method From January 2010 to December 2012,twenty-six cases of pan- creatic sinistral portal hypertension with splenomegaly were retrospectively analyzed. Results The underlying pancreatic diseases were chronic pancreatitis （n= 12, 46 %）, pancreatic pseudocyst （n=5, 19%）, mass of pancreatic body and tail （n=6, 23%）, autoimmunie panereatitis （n=2, 8%） and pancreatic trauma （n= 1, 4 %）. All the 26 patients presented with splenomegaly, but there was no ev- idence of cirrhosis or abnormal hepatic function. Three cases presented with a history of upper gastro- intestinal bleeding. Gastroscopy or upper gastrointestinal visualization revealed all 26 patients had vat- ices in the gastric fundus and 6 patients had inferior segment oesophageal varices simultaneously. 19 patients underwent operative treatment, 2 patients underwent splenic artery embolization and 5 pa- tients were treated conservatively. 22 patients were followed up for 6 months to 30 months, the fol- low-up rate was 85 %, and there were no upper gastrointestinal bleeding. Hypersplenism disappeared in all the 19 patients after operation. 2 patients succumbed to pancreatic malignant tumor. Conclusions Splenomegaly is one characteristic clinical manifestation of pancreatic sinistral portal hypertension. It could be cured by operation. The choice of treatment depends on the patient＇s condition. The manage- ment of the primary pancreatic disease should also be emphasized.

关 键 词：高血压 门静脉 胰腺疾病 脾大 

分 类 号：R657.3[医药卫生—外科学]