特发性门静脉高压症的诊治体会

Diagnosis and treatment of idiopathic portal hypertension

目的探讨特发性门静脉高压症(idiopathic portal hypertension,IPH)的诊断及治疗方法。方法回顾分析福州总医院肝胆外科自2006年6月～2011年1月收治的7例IPH患者的临床资料。结果 7例患者6例诊断为IPH,1例误诊为隐源性肝硬化;后均经病理证实为IPH。7例均行手术治疗:3例行手助腹腔镜改良Sugiura术,2例行脾切除+贲门周围血管离断术,1例行脾切除+贲门周围血管离断+远端脾肾分流术,1例行脾切除术。术后随访6个月～5年,平均2.3年,仅1例行脾切除+贲门周围血管离断术的患者术后1月出现黑便,经保守治疗好转。结论彩超对IPH的诊断有较高提示作用,但确诊均需病理证实;手术治疗IPH效果确切,对于伴食管胃底静脉重度曲张及巨脾的IPH患者,手助腹腔镜改良Sugiura术不失为一种安全、有效、微创的手术方式。

Objective To investigate the diagnosis and treatment of idiopathic portal hypertension. Methods The clinical data of 7 patients with idiopathic portal hypertension （IPH） treated between June 2006 and January 2011 in the Department of Hepatobiliary Surgery, Fuzhou General Hospital of PLA were analyzed retrospectively. Results Six cases were diagnosed as IPH, one misdiagnosed as eryptogenic cirrhosis. All cases were diagnosed as IPH by pathology. Simultaneously, seven patients were treaeted operations, including Hand-assisted laparoseopic modified Sugiura procedure（3 patients） , splenectomy and cardiac peripheral vascular disconnection（2 patients）, splenectomy and cardiac peripheral vascular disconnection and distal splenorenal shunt （1 patients ）, splenectomy （1 patients）. Patients were followed up for 6 months to 5 years, an average of 2. 3 years. Only one patient who treated the spleneetomy and cardiac peripheral vascular disconnection appeared melena one month after operation, but improved by conservative treatment. Conclusion The Color Doppler Ultrasound plays an important role in the diagnosis for IPH, but the diagnosis required pathology. Surgical treatment of IPH has a clear and definite effect. Hand-assisted laparoseopic modified Sugiura procedure is a safe,effective and minimally invasive method for the patient with severe esophageal and gastric veins varicose.