1例内镜序贯腹腔镜治疗食管静脉曲张伴门脉高压性胃病并文献复习  

Endoscopic sequential laparoscopic treatment of esophageal varices with portal hypertensive gastropathy:a case report and literature review

作　　者：张浩然 黄静 徐鹿平 吴一鸣 ZHANG Haoran;HUANG Jing;XU Luping;WU Yiming(Department of Gastroenterology,The First Hospital of Jiaxing,Jiaxing,Zhejiang,314000,China;Department of Hepatobiliary Surgery,The First Hospital of Jiaxin,Jiaxing,Zhejiang,314000,China)

机构地区：[1]嘉兴市第一医院消化内科,浙江嘉兴314000 [2]嘉兴市第一医院肝胆外科,浙江嘉兴314000

出　　处：《当代医学》2024年第13期101-104,共4页Contemporary Medicine

基　　金：浙江省科技厅项目(2017C33202)。

摘　　要：门脉高压性胃病(PHG)是门静脉高压的常见并发症,轻度慢性渗血较为常见,而急性出血较为少见,且较为严重,不易与食管静脉曲张破裂出血鉴别,预后较差。本研究报道1例女性患者,因急性消化道出血住院,急诊胃镜及门静脉CT血管造影(CTA)发现门静脉高压并食管静脉曲张合并PHG出血,行内镜下食管静脉曲张套扎术、药物保守治疗,控制急性出血,3个月后食管静脉曲张好转,PHG加重,进一步行腹腔镜脾切除术联合贲门周围血管离断术,术后随访预后较好,生命质量提高。食管静脉曲张同时合并PHG急性出血是门静脉高压少见的严重并发症,临床医师需重视治疗时机、治疗方式的选择。Portal hypertensive gastropathy(PHG)is a common complication of portal hypertension,mild chronic bleeding is more common,while acute bleeding is rare,and more serious,its difficult to distinguish from esophageal variceal bleeding,and has a poor prognosis.This paper reported one female patient who was hospitalized with acute gastrointestinal bleeding,emergency gastroscopy and portal vein CT angiography(CTA)found portal hypertension complicated with esophageal varices and PHG bleeding,endoscopic esophageal variceal ligation and conservative drug treatment were performed to control acute bleeding,after 3 months treatment,esophageal varices improved and PHG aggravated,after further laparoscopic splenectomy and pericardial devascularization,the prognosis was good and the quality of life was greatly improved.Esophageal varices combined with acute bleeding of PHG is a rare serious complication of portal hypertension,clinicians should pay attention to the choice of treatment time and treatment methods.

关 键 词：门脉高压性胃病 静脉曲张 腹腔镜 

分 类 号：R573[医药卫生—消化系统]