重症急性胰腺炎胰源性门静脉高压并发消化道出血(附5例诊治体会)

Diagnosis and Treatment for Pancreatogenic Portal Hypertension Complicated with Hemorrhage of Upper Digestive Tract in Severe Acute Pancreatitis:A Reort of 5 Cases

目的总结重症急性胰腺炎（SAP）胰源性门静脉高压并发消化道出血的病因、诊断和治疗经验。方法回顾性分析2002-11～2004-11间5例SPA胰源性门静脉高压并发消化道出血病人的临床资料，统计分析发生出血时间、出血量，治疗方法采用经导管动脉（出血处）栓塞术（TAE）止血，再行脾切除术治疗。结果出血多发生在SAP发病后6～8周，出血量平均1800mL。治疗采用TAE加脾动脉栓塞，均获暂时止血效果，2例复发出血病例再次栓塞，1例成功，1例死亡。存活的4例均行脾切除术后治愈。结论胰源性门静脉高压并发消化道出血是SAP后期少见并发症，选择性动脉造影是诊断胰源性门静脉高压的首选方法；对合并消化道大出血病人，TAE加脾动脉栓塞为首选治疗方法；胰源性门静脉高压最有效的治疗是脾切除。

Objective To sum up the etiology and the experience on diagnosis and treatment for pancreatogenic portal hypertension complicated with hemorrhage of upper digestive tract in severe acute pancreatitis（SAP） .Methods The clinical data of 5 SAP patients with pancreatogenic portal hypertension complicated whih hemorrhage of upper digestive tract from Nov. 2002 to Nov. 2004 were analyzed retrospectively. The bleeding time the volume of hemorrhage were analuzed by statistic methods.The nethods of treatment were transcatheter arterial embolization（TEA） and lienectomy.Results Hemorrhage often occurred in six to eight weeks late of SAP.The average volume of hemorrhage was 1800 mL.Five patients underwent partial splenic artery embolization and TAE. Hemostasis was succeeded in all patients provisionally. Two patients bleeding after TAE underwent second embolization. One patient was succeeded and one patint ided. Four survival patients were cured after lieneetomy. Conclusion Pancreatogenic portal hypertension complicated with hemorrhage of upper digestive tract is a rare complication in SAP. DSA is the preferred way to dignose pancreatogenic portal hypertension. Partial splenic artery embolization by TAE is the preferred way to treat the patients complicated with he,orrhage of upper digestive tract. Lieneetomy is the effective way to treat pancreatogenic portal hypertension.