胰源性门静脉高压症的诊断及外科治疗

Diagnosis and Surgical Treatment of Pancreatic Sinistral Portal Hypertension

目的：探讨胰源性门静脉高压症的临床特点、诊断及外科治疗方法。方法：回顾性分析本院2002年1月-2012年6月收治的45例胰源性门静脉高压症患者的临床资料。结果：男32例，女13例，年龄31-68岁，平均年龄（43．5±6．4）岁。胰腺原发病为慢性胰腺炎27例（60．0％，其中合并胰腺假性囊肿12例）；胰体、尾部胰腺癌9例（20．0％）；胰腺无功能性胰岛细胞瘤2例（4．4％）；胰腺囊腺瘤3例（6．7％）．外伤后胰腺假性囊肿4例（8．9％）。45例患者均伴有胃、食管静脉曲张，其中孤立性胃静脉曲张42例，胃静脉合并食管下段静脉曲张3例。术前有呕血和（或）便血史者19例（42．2％），有上腹不适、疼痛等腹部症状者33例（73．3％），伴有脾功能亢进者41例（91．1％）。45例患者均行手术治疗，术后胰漏2例，门静脉血栓5例，无围手术期死亡。42例患者获得随访，所有患者术后均未再出现消化道出血。结论：胰源性门静脉高压症是一种特殊类型的门静脉高压症，胰腺原发疾病的治疗是其治疗的关键，手术治疗可获良好效果。

Objective：To explore the clinical characteristics, diagnosis and surgical treatment of pancreatic sinistral portal hypertension（PSPH）. Methods：45 cases of PSPH treated in our hospital from January 2002 to June 2012 were analyzed retrospectively. Results：There were 32 males and 13 females,aged from 31 to 68 years old. The primary pancreatic disease was chronic pancreatitis in 27 patients （60. 0%, of which 12 cases combined with pancreatic pseudocyst）, pancreatic body and tail cancer in 9 cases （20. 0 %）, non-functional islet cell tumors in 2 cases （4. 4 %）, pancreatic cystadeno main 3 cases （6. 7%）, and pancreatic pseudocyst after trauma in 4 cases （8, 9%）. All 45 patients developed gastro esophageal variees, including 42 isolated gastric varices and 3 gastric varices incorporated with esophageal varices. There were 19 patients have apre operative hematemesis and （or） hematochezia（42. 2%） ; 33 cases have an upper abdominal discomfort, pain or other abdominal symptoms（73. 3%）; and 41 cases accompanied with hypersplenism （91.1%）. All of the 45 patients underwent surgical treatment,2 cases had pancreatic leakage after surgery,and 5 cases had partial portal vein thrombosis after surgery, no perioperative mortality. 42 patients were followed-up, no massive digestive tract re-bleeding occurred. Conclusion： PSPH is a special type of portal hypertension; the key step is to cure the primary pancreatic disease; surgical treatment can get excellent results.