门静脉海绵样变致食管胃底静脉曲张的手术治疗(附1例报告)  

Surgical treatment of esophagogastric varices from cavernous transformation of portal vein:one case report

作　　者：孙隆慈[1] 张斌[1] SUN Longci;ZHANG Bin(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127

出　　处：《外科理论与实践》2021年第3期226-230,共5页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨门静脉海绵样变(cavernous transformation of portal vein,CTPV)合并食管胃底静脉曲张的治疗方法。方法:回顾性分析2020年在本院胃肠外科治疗的1例21岁男性CTPV病人。结果:病人因血液检查白细胞(1.38×10^(9)/L)和血小板(37×10^(9)/L)降低行腹部增强CT检查,发现门静脉主干闭塞,阻塞近端有较多侧支血管。肝炎标志物均阴性,Child-Pugh A级。诊断为CTPV,伴有重度食管胃底静脉曲张、重度脾肿大、脾功能亢进。行脾切除+脾肾静脉分流+贲门周围血管离断术。术后恢复良好,无肝性脑病表现。腹部增强CT检查示脾肾静脉分流口通畅。结论:CTPV合并重度静脉曲张和重度脾肿大、脾功能亢进者,可行预防性分流加断流术。Objective To discuss the treatment of esophagogastric varices from cavernous transformation of portal vein(CTPV).Methods A 21-year-old male patient with CTPV from Department of Gastrointestinal Surgery Renji Hospital in 2020 was analyzed retrospectively.Results The patient was admitted with lower WBC count 1.38×10^(9)/L and lower platelet count 37×10^(9)/L and abdominal enhanced CT scan showed main portal vein obliteration and collateral vessels proximal to the obstruction.The examination revealed negative hepatitis markers and Child-Pugh A stage.He was diagnosed as CTPV associated with large esophagogastric varices,massive splenomegaly and hypersplenism.He underwent splenectomy,splenorenal shunting and pericardial devascularization and the postoperative recovery was uneventful without hepatic encephalopathy.Postoperative abdominal CTA was suggestive of splenorenal shunt patent.Conclusions It was suggested that preventive shunting and devascularization were suitable for CTPV associated with large esophagogastric varices,massive splenomegaly and hypersplenism.

关 键 词：门静脉海绵样变 食管胃底静脉曲张 门静脉高压症 脾肾静脉分流术 

分 类 号：R657.34[医药卫生—外科学]