胰源性门静脉高压症的诊断与治疗

Diagnosis and management of pancreatic regional portal hypertension

目的总结胰源性门静脉高压症的诊断与治疗经验。方法回顾性分析40例胰源性门静脉高压症患者的临床表现、诊治和疗效。结果本组40例患者中男26例，女14例，平均年龄（404-10）岁；16例合并上消化道出血，20例合并脾功能亢进；胰体尾良性肿瘤16例，恶性肿瘤6例，重症胰腺炎合并胰腺假性囊肿8例，慢性胰腺炎10例。胰源性门静脉高压组脾静脉压力为（28．4±4．2）amH2O,与对照组相比差异有统计学意义，P〈0．01。Doppler超声测定脾静脉直径和流速分别为（1．3±0．2）cm和（9．3±0．5）cm/s，与对照组相比差异有统计学意义，分别P〈0．01、P〈0．05。36例行手术治疗，其中20例因脾功能亢进行脾切除，有2例加行贲门周围血管离断术，其余16例针对原发疾病行外科处理。另4例行内镜硬化治疗。随访率为100％。患者术后预后佳，无上消化道出血复发。结论超声、CT和内镜检查结合患者的临床表现，诊断胰源性门静脉高压症并不困难。治疗策略既要解决区域性门静脉高压症，又要针对原发病灶。

Objective To summarize clinical experience on the diagnosis and management of pancreatic regional portal hypertension. Methods The clinical manifestations, diagnostic methods and therapeutic modalities of dO cases of pancreatic regional portal hypertension were analyzed retrospectively. Results Male： female = 26： 14. The average age was （40 ± 10） yrs. Among these patients, 16 patients （40%） were accompanied by upper gastrointestinal bleeding and 20 patients （50%） by hypersplenism. There were 16 patients （40%） suffering from benign lesions and 6 patients （15%） from malignancy at pancreatic body and tail respectively, and 8 patients（20% ） from severe necrotic pancreatitis accompanying pseudocyst and 10 patients （25%） from chronic pancreatitis. The average splenic venous pressure was （28.4 ± 4. 2） cm H2 0 （ P 〈 0. 01 ）. The average diameter and speed of splenic vein bloodflow by Doppler examination was （ 1.3 ± 0. 2 ） cm （ P 〈 0. 01 ） and （ 9. 3 ± 0. 5 ） cm/s （ P 〈 0. 05 ）. The follow-up rate was 100%. Splenectomy was effective for controlling gastrointestinal bleeding. Conclusions It is not difficult to diagnose pancreatic regional portal hypertension based on findings of US, CT and endoscopic examination, together with its clinical features. Therapy should be aimed at both regional portal hypertension and underlying diseases.