胰源性区域性门脉高压症的临床表现、诊治及疗效  

Clinical manifestations, diagnosis and treatment of pancreatic segmental portal hypertension

作　　者：石瑞春 杨志伟 杨理华 

机构地区：[1]吴忠市人民医院消化内科,宁夏回族自治区吴忠市751100

出　　处：《世界华人消化杂志》2014年第26期4003-4007,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨胰源性区域性门脉高压症(pancreatogenic segmental portal hypertension,PSPH)的临床表现、诊治及疗效分析.方法:选取2011-02/2014-02吴忠市人民医院收治的PSPH患者共48例(PSPH组),非胰源性门脉高压患者20例(对照组).分别对其临床表现、血流动力学变化以及各静脉压力进行评价与统计学分析.结果:PSPH组的48例患者中慢性胰腺炎占21例,胰腺假性囊肿11例,胰腺体尾部恶性肿瘤5例,体尾部良性肿瘤3例.27例治愈(56.25%)且均出现脾脏肿大及上消化道出血症状,患者中出现单纯胃底静脉曲张37例(77.08%),胃底合并食管静脉曲张8例(16.67%),食管下段静脉曲张3例(6.25%).PSPH组肠系膜上静脉和门静脉的直径和流速与对照组相比无统计学差异(P>0.05),但PSPH组脾静脉血液的平均流速低于对照组,而直径及脾静脉压均高于对照组,差异均有统计学意义(P<0.05).结论:通过临床表现、内镜以及多普勒超声检查相结合,可基本确诊PSPH.在治疗时,应兼顾原发胰腺疾病与门静脉高压症状,合理使用手术及药物治疗.AIM： To explore the clinical presentations, di- agnosis and treatment of pancreatic segmental portal hypertension （PSPH）. METHODS： Forty-eight patients with PSPH treated from February 2011 to February 2014 at our hospital were included （PSPH group）, and another 20 patients with non-pancreatic portal hypertension were used as controls （control group）. Clinical manifestations, hemodynamic changes and the venous pressure were evalu- ated and statistically analyzed. RESULTS： Of all 48 patients in the PSPH group, 21 were accompanied by chronic pancreatitis and 11 by pancreatic pseudocyst; 5 suffered from pancreatic body and tail cancer and 3 from pancreatic benign tumors; 27 （56.25%） were cured and all of them showed enlarged spleen and upper gastrointestinal bleeding; 37 （77.08%）had simple varices, and 8 （16.67%） had com- bined gastric and esophageal varices; 3 （6.25%） had varices of the lower esophagus. The diam- eters and flow rates of the superior mesenteric vein and portal vein in the PSPH group were not significantly different from those in the control group （P 〉 0.05）, but the average velocity of the splenic vein blood was significantly lower and the splenic vein diameter and pressure were sig- nificantly higher in the PSPH group than in the control group （P 〈 0.05）. CONCLUSION： PSPH can be diagnosed correct- ly based on clinical presentations, endoscopic findings and Doppler ultrasound findings. In the treatment of PSPH, the primary pancreatic dis- ease and portal hypertension symptoms should be taken into account in order to rationally use surgery and drug therapy.

关 键 词：胰腺疾病 门脉高压症 诊断 脾静脉 

分 类 号：R576[医药卫生—消化系统]