胰源性门脉高压症25例临床分析

Analysis of 25 cases pancreatic segmental portal hypertension

目的:探讨胰源性门脉高压症的病因和临床特征。方法:回顾性分析25例胰源性门脉高压症患者的临床资料。结果:此25例占同期门脉高压症患者的2.1%。病因依次为慢性胰腺炎、胰腺癌、胰腺囊肿、急性胰腺炎。胃、食管静脉曲张20例,其中孤立性胃底静脉曲张18例,曲张静脉破裂出血12例;脾肿大25例,其中脾功能亢进15例;脾静脉阻塞25例,肠系膜上静脉阻塞4例,门静脉阻塞3例。20例患者有明确的侧支循环形成,胃短静脉、胃网膜静脉及胃冠状静脉是常见的增粗血管。14例行外科手术治疗,11例予内科保守治疗。结论:胰腺疾病可导致广泛性或区域性门脉高压症;该症具有特征性的胃周侧支循环,这对其诊断和临床治疗有指导意义。

[ Abstract] Objective： To analyze the etiology and clinical features of pancreatic segmental portal hypertension （PSPH）. Methods： A retrospective analysis was carried out in 25 cases with PSPH in our hospital from January 2008 to October 2013. Medical records of these patients were reviewed, including data of etiologies, clinical presentation, collateral pathways and therapeutic modalities. Results ： There were 25 cases of PSPH in our hospital, accounting for 2. 1% of all portal hypertension. The etiologies were chronic pancreatitis, pancreatic carcinoma, pancreatic cysts, acute pancreatitis. Twenty patients developed gastroesophageal varices （including 18 isolated gastric varices）. Among them, 12 cases had bled. Splenomegaly was present in 25 cases. Fifteen cases had concomitant hypersplenism. Splenic vein obstruction occurred in 25 cases, followed by superior mesenteric vein obstruction in 4 cases and portal vein involvement in 3 cases. Of the 20 patients whose collateral pathways were identified, short gastric vein, gastroepiploic vein and coronary gastric vein were commonly dilated. Surgery was performed in 14 cases and the remaining 11 cases received medical treatment. Conclusion： Pancreatic diseases may lead to generalized or regional portal hypertension. PSPH has characteristic perigastric collateral vessels which are important to the diagnosis and therapy of PSPH.