慢性胰腺炎并发门静脉高压症

PORTAL HYPERTENSION RESULTED FROM CHRONIC PANCREATITIS

目的:探讨慢性胰腺炎并发门静脉高压症的诊断和治疗。方法:回顾性分析我院1990年3月至2005年10月收治的慢性胰腺炎所致的胰源性门静脉高压症21例,其中左侧门静脉高压症16例,肝前型门静脉高压症5例。其诊断依据主要依靠多普勒超声,CT和MR等影象学检查和上消化道内镜检查,肝前性门静脉高压症有时须行MRA或肠系膜上动脉血管造影。治疗左侧门静脉高压症可行脾切除术,肝前型门静脉高压症有出血史者可行肠系膜上静脉、下腔静脉分流术,必要时加行脾切除术。结果:21例均获随访,随访时间1～5年,患者恢复良好,脾亢纠正,15例行上消化道内镜复查,曲张静脉消失或仅有轻度曲张,10例有出血史者未再发性出血。结论:注意慢性胰腺炎所致的胰源性左侧门静脉高压症的诊断治疗的同时应注意SMV-PV阻塞所致的肝前性门静脉高压症的诊治。

Objective; To explore the diagnosis and management of portal hypertension resulted from chronic pancreatitis. Method： The clinical manifestations, diagnostic methods and therapeutic modalities of 21 cases of portal hypertension resulted from chronic pancreatitis （ 16 regional portal hypertension, 5 prehepatic portal hypertension ） in our hospital from Mar, 1990 to Oct. 2005 were analyzed retrospectively. The main diagnostic methods were ultrasonography （ US ）, computerized tomography （ CT ） and endoscopy. Magnetic resonance angiography （ MRA ） and superior rnesentayy angiography were performed selectly in 3 prehep- atic portal hypertension. Splenectomy were performed in 16 regional portal hypertension, and superior mesenteric vein - inferior vena cava shunt were the treatment of choice in 5 prehepatic portal hypertension （ plus splenectomy in 2 cases） . Results： All the patients were followed up for 1 - 5 years and recovered nicer after treatment. No cases of rebleeding occurred in the peroid of follow - up. Hypersphnism disappeared, and disappeared or improved obviously esophageal varices had be detected by gastroscope in 15 cases after operation. Results： In the clinical procedure of pancreatic portal hypertension resulted from chronic pancratitis, prehepatic portal hypertension should be considered as well as sinistral portal hypertension.