胰源性区域性门脉高压症的诊断与治疗

The diagnosis and treatment of pancreatic segmental portal hypertension

目的 探讨胰源性区域性门脉高压症诊断和治疗方法.方法 回顾性分析2003年1月-2013年2月南京市鼓楼医院收治的胰源性区域性门脉高压症患者28例的诊疗过程和随访资料.结果 28例患者中胰腺神经内分泌肿瘤4例,胰腺癌8例,胰腺假性囊肿10例,慢性胰腺炎6例,其中合并有呕血和（或）黑便史14例,所有患者均无肝硬化、腹水及肝功能异常等表现.纤维胃镜和超声内镜提示胃底静脉曲张20例,合并食管下段静脉曲张6例.28例患者均有脾肿大和脾功能亢进的表现.28例患者均采用手术治疗,手术均较顺利.8例胰体尾癌患者于术后3～9个月死亡.余20例患者中随访18例,随访时间为5个月～8年.定期复查内镜,食道下段及胃底周围曲张静脉明显改善或消失,均无再出血.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. Methods Retrospectively analyzed the 28 cases of pancreatic segmental portal hypertension in Nanjing Drum Tower Hospital from January 2003 to Febrary 2013. Results The underlying pancreatic diseases were pancreatic endocrine tumor （4 case）, pancreatic cancer （8 case） ,pancreatic pseudocyst （10 case） and chronic pancreatitis （6 case） and 14 cases had the history of upper gastrointestinal bleeding. None of the patients had cirrhosis, ascites or abnormal hepatic function. Endoscopy and endoscopic ul- trasound revealed that 20 patients had variees in the gastric fundus of which 6 patients had oesophageal varices simultaneously. All patients presented splenomegaly and hypersplenism. All patients underwent operation treatment. 28 patients with surgery were successfully. 8 cases of pancreatic body and tail cancer patients dead after 3 -9month. 18 cases patients were followed up for 5 months to 8 years, periodic review of endoscopy, around the lower esophagus and gastric variees significantly improved or disappeared, no further bleeding. Conclusion Isolated gastric varices, splenomegalia and hypersplenism, normal liver function and pancreatic disease history can help to diagnose. Pancreatic segmental portal hypertension can be cured by splenectomy or extensive pericardia] devascularization, and the management of primary pancreas disease shall also be emphasized.