继发性胆汁性肝硬变门脉高压症的诊断和治疗

DIAGNOSIS AND TREATMENT OF PORTAL HYPERTENSION IN SECONDARY BILIARY CIRRHOSIS

目的 探讨继发性胆汁性肝硬变门脉高压症的诊断和治疗。方法 对我院近 16年来收治的 2 5例该病患者作回顾性研究 ,按原发病分为 4组 ;肝胆管结石 13例、术后胆管狭窄 6例、胆道恶性肿瘤 4例、其他 2例。分析其临床及病理资料 ,并予随访。结果 2 5例均经临床诊断 ,4例还经病理证实。非手术治疗 8例 ;手术治疗 17例 ,均针对原发病 ,1例同时行脾切除、胃底静脉离断术。手术治疗和非手术治疗的好转出院率分别为 64 7%和 3 7 5 % ,院内死亡率分别为 17 6%和 12 5 %。结论 该病的诊断主要依靠其特征性临床表现 ;治疗首先应针对原发病 ,争取早期手术解除胆道梗阻 ;

Objective\ To study the diagnosis and treatment of portal hypertension in secondary biliary cirrhosis(PHSBC). Methods\ Twenty-five cases of PHSBC within recent 16 years in our hospital were analyzed. Their clinical, pathological and follow-up data were reviewed retrospectively. They were divided into 4 groups according to their primary diseases:13 patients with hepatolithiasis, 6 with postoperative stricture of biliary duct, 4 with malignancy of biliary duct and 2 with others. Results\ All patients were diagnosed clinically, and 4 were further pathologically confirmed. Eight cases were treated conservatively, while the remaining 17 underwent operations according to their primary diseases, and one combined with splenectomy and esophagogastric devascularization. The rate of discharge with improvement by surgical and non-surgical treatment was 64 7% and 37 5%, and hospital mortality was 17.6% and 12.5% respectively. Conclusion\ The diagnosis of PHSBC mainly depends on its characteristic clinical manifestations. The early surgical resolution of bile duct obstruction is the key to good prognosis. If complicated with rupture and hemorrhage of oesophagofundal varices, the surgical procedure should be considered carefully.