胰源性门脉高压症的临床特征

Clinical features of panereatic disease-associated portal hypertension

目的探讨胰腺疾病相关性门脉高压症的临床特点及治疗。方法选择广东省人民医院和中山大学附属第二医院医院1998年1月~2009年1月收治的胰腺疾病相关性门脉高压症患者,回顾性分析其一般资料、受累静脉、临床表现、实验室和影像检查、治疗和结局。结果 11年共收治本病52例,占同期门脉高压症的4.58%。常见基础胰腺疾病依次为慢性胰腺炎21例、胰腺肿瘤15例、急性胰腺炎和胰腺假性囊肿14例,其他胰腺疾病2例;52例患者有明确的受累静脉,脾静脉是最常受累的静脉（38例,73.1%）,其次为门静脉21例（40.4%）,肠系膜上静脉阻塞11例（21.2%）,无单独受累者。脾脏肿大48例（81.4%）,为轻、中度肿大,脾功能亢进31例（52.5%）,程度较轻,以白细胞减少为主。45例患者（76.3%）有胃、食管静脉曲张（孤立性胃静脉曲张35例）,22例有破裂出血（42.3%）。药物治疗可控制急性出血,但不能预防再出血。23例行脾切除术,主要指征是反复发生的消化道出血,术后患者均未再出血（随访6个月~6年）。结论胰腺疾病可累及门静脉主干及其属枝,导致广泛性或区域性门脉高压症。药物治疗可有效控制急性曲张静脉破裂出血,而手术可能是防止再出血的主要措施。

Objective To investigate the clinical features and management of pancreatic disease-associated portal hypertension.Methods A retrospective analysis was carried out in patients with portal hypertension and concurrent pancreatic diseases.The medical records of these patients were reviewed including the data of demographics,etiologies,venous involvement,clinical presentations,laboratory tests,imaging studies,therapeutic modalities and outcomes.Results Fifty-two patients with portal hypertension resulting from pancreatic diseases were found in our hospital,accounting for 4% of all the patients with portal hypertension in 11 years.The underlying pancreatic diseases were chronic pancreatitis（21 cases,35.6%）,pancreatic carcinoma（20 cases,33.9%）,acute pancreatitis（8 cases,13.6%）,pancreatic pseudocyst（3 cases,5.1%）.Of the 40 patients whose venous involvement was identified,splenic vein obstruction occurred in 27 cases（67.5%） and portal vein obstruction in 16 cases（40.0%）.Mild or moderate splenomegaly was present in 48 cases（81.4%）,with leukocytopenia as the most common manifestation of the 31 cases（52.5%） with concomitant hypersplenism.Forty-five patients（76.3%） developed gastroesophageal varices（including 35 with isolated gastricvarices）,and among them 22 experienced bleeding（42.3%）.Conservative treatment was effective in controlling acute bleeding,but could not prevent re-bleeding.Splenectomy was performed in 18 patients mainly due to gastrointestinal hemorrhage.No postoperative bleeding occurred during the follow-up ranging from 8 months to 9 years.Conclusions Pancreatic diseases may compromise portal vein and its tributaries,leading to generalized or regional portal hypertension.Pharmacological therapy can effectively control acute variceal bleeding,while surgical treatment is the appropriate procedure of choice in case of hemorrhagic recurrence.