左侧门脉高压症的诊治体会  

Diagnosis and treatment of left portal hypertension

作　　者：谢青松 陈子祥 顾恒 赵义军[1] 耿小平[1] 刘付宝[1] XIE Qing-song;ZHAO Yi-jun;CHEN Zi-xiang(The first Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院肝胆胰外科,合肥230022

出　　处：《肝胆外科杂志》2020年第3期179-185,共7页Journal of Hepatobiliary Surgery

摘　　要：目的探讨左侧门脉高压症的诊治体会。方法回顾分析安徽医科大学第一附属医院近10年收治24例左侧门脉高压症患者术前检查、治疗方法及手术技巧和随访结果。结果24例左侧门脉高压症患者均继发于胰腺疾病,反复发作胰腺炎17例(70.8%),胰腺癌4例(16.7%),医源性1例(4.2%),慢性胰腺炎2例(8.3%),主要临床表现为腹痛(37.5%)、脾大(100%)、消化道出血(58.3%)、腹部包块(12.5%)。影像学发现脾静脉栓塞或者狭窄者(10/24)例,脾静脉造影证实脾静脉梗阻(2/2)例,胃镜检查发现孤立性胃底静脉曲张(14/19)例,孤立性食管下段静脉曲张(5/19)。共19例患者获得随访(79.2%),随访时间1~128个月。15例患者(62.5%)采取手术治疗,手术方案主要是脾切除或联合胰尾切除或联合门奇静脉断流术,术中出血超过500ml者8例,大于1000ml者3例,且15例手术患者均获得随访,手术治疗对消化道出血效果确切。结论左侧门脉高压临床特征明确,诊断确切,若有消化道出血,应行手术治疗,但反复发作的胰腺炎会导致左侧门脉高压症患者胰腺粘连致密从而增大手术难度,因此应做好充分的术前准备。Objective To explore the perioperative management for left portal hypertension.Methods The preoperative examination,treatment methods,surgical skills and follow-up results of 24 patients with left portal hypertension in our hospital in the past 10 years were retrospectively analyzed.Results All 24 patients with left portal hypertension were secondary to pancreatic disease,specifically,17 cases(70.8%)with recurrent pancreatitis,4 cases(16.7%)with pancreatic cancer,1 case(4.2%)was iatrogenic and 2 case(8.3%)with chronic pancreatitis.The main clinical manifestations include abdominal pain(37.5%),splenomegaly(100%),gastrointestinal bleeding(58.3%)and abdominal mass(12.5%).Imaging examinations revealed that splenic vein embolism or stenosis was found in 10 of 24 patients.Splenic venography confirmed that splenic vein obstruction was found in 2 of 2 patients.Gastroscopy revealed that isolated gastric varices and solitary varices of the lower esophagus were found in 14 and 5 of 19 patients respectively.Totally,19 patients were followed up(79.2%)and the follow-up period was 1-128 months.15 patients(62.5%)underwent surgery,the surgical treatments mainly include splenectomy and combined pancreatectomy.8 cases were found bleeding more than 500 ml and 3 cases were found bleeding more than 1000 ml.Moreover,all 15 patients treating with surgery were followed up.Surgical treatment is definitely effective for patients with gastrointestinal hemorrhage.Conclusion The clinical features of the left portal hypertension are clear and the diagnosis is accurate.Surgery should be performed when there is gastrointestinal bleeding.Notably,the surgery for patient with left portal hypertension accompanied by recurrent pancreatitis is difficult due to dense pancreatic inflammation and adhesion,therefore,sufficiently preoperative preparation were needed.

关 键 词：左侧门静脉高压 胰腺炎 胰腺假性囊肿 消化道出血 脾切除 

分 类 号：R658[医药卫生—外科学]