慢性胰腺炎并发门静脉高压症

Portal hypertension due to 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。方法回顾性分析该院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、CY和MR等影像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，病人恢复良好，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生出血。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 due to chronic pancreatitis. Methods The clinical manifestations, diagnostic methods and therapeutic modal- ities of 21 cases of portal hypertension due to chronic pancreatitis（16 with regional portal hypertension, 5 prehepatic portal hypertension） treated in our hospital from March 1990 to October 2005 were retrospectively analyzed. The main diagnostic methods were ultrasonography （US）, computerized tomography（CT） and endoscopy. Magnetic resonance angiography（MRA） and superior mesenteric angiography were performed selectively in 3 with prehepatic portal hypertension. Splenectomy was performed in 16 patients with regional portal hypertension, and superior mesenteric vein-inferior vena cava shunt was the treatment of choice in 5 with 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 case of rebleeding occurred during the follow-up. Hypersplenism disappeared, and disappeared or improved obviously. Esophageal varices was detected by gastroscope in 15 cases after operation. Conclusion In the clinical procedure of pancreatic portal hypertension due to chronic pancreatitis, prehepatic portal hypertension should be noted.