胰体尾肿瘤致胰源性门静脉高压症的临床分析  

Sinistral portal hypertension caused by body and tail tumors of the pancreas in 40 cases

作　　者：李晓斌[1] 廖泉[1] 穆冰[1] 徐强[1] 丛林[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院基本外科,100730

出　　处：《中华普通外科杂志》2014年第8期610-612,共3页Chinese Journal of General Surgery

基　　金：卫生行业科研专项项目“门静脉高压症治疗方法的合理选择和推广应用”基金资助项目（201002015）

摘　　要：目的 探讨胰体尾肿瘤导致胰源性门静脉高压症的临床特点和诊治方法.方法 回顾性分析北京协和医院2007年1月至2012年12月诊治的40例胰体尾肿瘤导致胰源性门静脉高压症患者的临床资料.结果 本组40例胰源性门静脉高压症患者的首发症状分别为上腹部疼痛及不适12例,明显消瘦5例,腰背痛4例,脾肿大2例,呕血、黑便4例,低血糖昏迷1例.40例患者肝功能均正常,均有脾肿大和胃底静脉曲张,其中8例伴有食管下段静脉曲张,24例脾功能亢进,26例血清CA19-9升高.25例患者行手术治疗,15例行保守治疗.病理检查结果显示胰腺恶性肿瘤29例,良性肿瘤11例.35例患者获得随访,随访率为88％,随访时间12 ～ 72个月.接受手术治疗的患者在随访期间未出现上消化道出血,手术后脾功能亢进和胃底静脉曲张消失;非手术治疗患者在随访期间脾功能亢进程度无明显加重,有4例患者出现上消化道出血,经过药物治疗、内镜治疗和介入治疗后成功控制出血.结论 胰体尾肿瘤导致的胰源性门静脉高压症手术治疗效果满意,门静脉高压症的临床表现可作为首发症状出现.Objective To evaluate the clinical characteristics,diagnosis and treatment method of pancreatic sinistral portal hypertension caused by tumors in the body and tail of the pancreas.Methods A retrospective review of 40 patients diagnosed with pancreatic sinistral portal hypertension at Peking Union Medical College Hospital from January 2007 to December 2012 was performed.Results The Initial symptoms were epigastric pain and discomfort （n =12）,emaciation （n =5）,low-back pain （n =4）,splenomegaly （n =2）,hematemesis and melena （n =4）,hypoglycemic coma （n =1）.All 40 patients had splenomegaly and varices in the gastric fundus with normal liver function.8 had combined esophageal varices.24 had hypersplenism and 26 had elevated serum CA19-9 level.25 patients received surgical intervention and 15 were treated conservatively.Pathology confirmed malignancy in 29 patients and benign lesions in 11.Thirty-five patients （35/40,88％） were followed up for 12 to 72 months.For patients undergoing surgery,hypersplenism and varices in the gastric fundus were all relieved.There was no upper gastrointestinal bleeding occurred during follow-up.For patients treated conservatively,hypersplenism remained stable and among them 4 patients had upper gastrointestinal bleeding,and successfully treated by medication,therapeutic endoscopy and interventional therapy.Conclusions Patients with pancreatic sinistral portal hypertension caused by tumor in the body and tail of the pancreas can be cured successfully by surgery.In those patients portal hypertension can present as initial clinical manifestation.

关 键 词：胰腺肿瘤 高血压 门静脉 食管和胃静脉曲张 

分 类 号：R735.9[医药卫生—肿瘤]