门静脉海绵样变性21例外科治疗

Surgical treatment of portal vein cavernous transformation in 21 cases

目的：探讨门静脉海绵样变性（CTPV）的手术治疗方法。方法回顾性分析2002年1月至2012年1月经手术治疗的21例门静脉海绵样变性的临床资料。结果21例均有上消化道出血病史，行脾切除＋贲门周围血管离断术8例；贲门周围血管离断术5例；胃冠状静脉结扎术1例；近端脾-肾分流术1例；脾切除＋贲门周围血管离断＋胃底部分切除术1例；贲门周围血管离断联合食管下段横断术1例；单纯脾切除术1例；1例门脉高压性胆病行胆囊空肠吻合术；1例合并肝门部胆管癌，行肝Ⅳ段切除＋胆总管切除＋肝总管空肠Roux-en-Y吻合术；1例合并肝细胞肝癌并肝总管癌栓，行肝总管切开取癌栓＋T管引流＋肿瘤微波固化。术后3例失访，其余18例随访5~138个月，平均（43.2±28.8）个月。2例分别于术后23个月、49个月再次出现上消化道出血，1例行内镜下套扎止血，1例行保守治疗好转，术后96个月死于乳腺癌，2例合并恶性肿瘤者分别在术后5个月、8个月死于多器官功能衰竭，其余14例患者术后无不良情况发生。结论脾切除＋贲门周围血管离断术可有效治疗门静脉海绵样变性引起的上消化道出血并延长再次出血时间。

Objective To investigate the efficiency of surgical treatment of portal vein cavernous transforma-tion （CTPV）. Methods The clinical data of 21 patients with CTPV who were performed surgery from January 2002 to January 2012 were analyzed retrospectively. Results All 21 cases had upper gastrointestinal bleeding, among which 8 cases underwent splenectomy plus devascularization, 5 cases underwent devascularization. Another 5 patients underwent coronary vein ligation, proximal splenorenal shunt, splenectomy plus devascularization plus cardio-gastrectomy, devas-cularization plus esophageal transaction and splenectomy respectively. The remained three cases including one case with symptomatic portal biliopathy received gall badder-jejunal anatomosis, one case with hilar cholangiocarcinoma received hepatectomy plus hepatic-jejunal anatomosis with Roux-en-Y, and one case with hepatocellular carcinoma with portal veinous tumor thrombi received drainage and microwave therapy. The mean time of following up for 18 cases was （43.2± 28.8） months （from 5 to 138）, whereas 3 cases were lost. Bleeding recurred in 2 patients at 23 and 59 months after sur-gery, treated with endoscopic bland ligation or medicine, respectively, and the latter died of breast cancer 96 months after surgery. Two patients with malignancies died of multiorgan disfunction 5 or 8 months postoperatively, while the remain-ing 14 patients were asymptomatic. Conclusion Splenectomy plus devascularization is an effective choice for treating CTPV patients with upper gastrointestinal bleeding and would prolong the occurrence of bleeding again.