门静脉海绵性变11例诊疗分析

The diagnosis and treatment of 11 cases of portal vein cavernous transformation.

目的探讨门静脉海绵性变的临床特点、病因、诊断与治疗方法。方法对11例门静脉海绵样变性患者的症状、体征和辅助检查结果进行回顾性分析。结果11例患者多以消化道出血、脾肿大、脾功能亢进为首发症状,成人门静脉海绵性变多为癌栓引起,除外因肝脏疾病继发门静脉海绵性变,其他患者肝功能检查基本为Child A级。5例超声检查、3例CT、1例MRI、3例DSA检查确诊。所有患者进行内科治疗都能取得短期疗效,但是容易反复,2例患者行脾切除加门奇静脉断流术治疗。结论门静脉海绵性变的临床表现以门静脉高压为主,彩色多谱勒超声可确诊大多数病例。内科治疗能取得较好短期疗效,但易复发。目前以手术治疗为主,手术方法主要采取门体静脉分流术。

Objective To investigate the clinical feature, etiology, diagnosis and treatment of cavernous transformation of the portal vein （CTPV）. Methods A retrospective study was made on clinical data of 11 patients with CTPV. Results A total of 11 patients had portal hypertension. Tumor was the most important etiology of CTPV in adult. Apart from liver diseases due to CTPV, the liver function could be classified as Child A. The diagnosis of cavernous transformation was confirmed by color Doppler ultrasonography, CT, MRI or DSA in all patients. Medical Splenectomy and devascularization were performed on 2 cases. Conclusion treatment was efficient but patients rebled easily. Feature of CTPV is portal hypertension. Doppler ultrasound can identify the CTPV generally. Recently CTP.V is mostly treated by surgical methods and the operation choice is portasystemie shunt.