胰源性区域性门脉高压症合并上消化道出血的诊治分析

The diagnosis and treatment of pancreatic segmental portal hypertension with upper gastrointestinal bleeding

目的探讨胰源性区域性门脉高压症合并上消化道出血的诊断和治疗方法。方法回顾分析我院2000年1月至2011年2月收治的14例胰源性区域性门脉高压症合并上消化道出血患者的诊疗措施和随访资料。结果 14例患者中胰体尾占位6例,胰腺假性囊肿4例,慢性胰腺炎4例。均有呕血或(和)黑便史,其中4例有失血性休克表现。所有患者均无肝硬化、腹水及肝功能异常等表现。胃镜和超声胃镜提示14例患者均有胃底静脉曲张,2例同时合并食管下段静脉曲张。8例患者有脾肿大和脾功能亢进的表现。14例患者均采用手术治疗。9例患者获得随访,曲张静脉明显改善或消失,随访5月～8年均无出血复发。结论孤立性胃底静脉曲张、脾肿大和脾功能亢进、无肝硬化和肝功能正常以及胰腺疾病病史是诊断胰源性区域性门脉高压症的基本要点。该疾病可通过脾切除术或联合胃底周围血管离断术治愈,应同时重视对胰腺原发疾病的治疗。

Objective To explore the diagnosis and treatment of pancreatic segmental portal hypertension with upper gastrointestinal bleeding. Methods From January 2000 to February 2011, fourteen cases of pancreatic segmental portal hypertension with upper gastrointestinal bleeding in our hospital were retrospectively analyzed. Results The underlying pancreatic diseases were mass of pancreatic body and tail （ n = 6）, pancreatic pseudocyst （ n = 4） and chronic pancreatitis （ n = 4）. All the patients presented with hematemesis or melena and four patients manifested hemorrhagic shock. All the patients had no evidence of cirrhosis, ascites and abnormal hepatic function. Endoscopy and endoscopic ultrasound revealed that all the patients had varices in the gastric fundus and two patients had oesophageal varices simultaneously. Eight patients presented with splenomegaly and hypersplenism. All the patients underwent operation treatment. Nine patients were followed up for 5 months to 8 years, and there were no rebleeding. Conclusion Isolated gastric varices, splenomegalia and hypersplenism, normal liver function and the history of pancreatic disease could help to diagnose. Pancreatic segmental portal hypertension could be cured by sple- nectomy and extensive pericardial devascularization, and the management of primary pancreas disease should also be emphasized.