胰腺炎相关区域性门静脉高压伴上消化道大出血的治疗

Treatment of massive variceal bleeding secondary to localized pancreatitis-associated portal hypertension

目的探讨胰腺炎相关区域性门静脉高压伴上消化道大出血（MVBPAPH）的治疗方案。方法回顾性分析24例MVBPAPH患者临床资料，所有患者均有重度胃体底静脉曲张破裂大出血。其中，20例患者伴有胰腺假性囊肿，12例为急诊胃镜纤维蛋白胶注射止血失败后手术（脾切除联合胃底体周围血管离断术10例，单纯胰腺囊肿胃引流2例），8例接受部分脾栓塞＋胃网膜左动脉栓塞，4例直接行手术（脾切除联合胃底体周围血管离断术）治疗。结果栓塞治疗的8例患者中，有5例出现反应性左侧胸腔积液。手术治疗的16例患者中，2例于术后出现左侧胸腔积液和肺部感染，经积极治疗后恢复。所有患者术后病情稳定，痊愈出院。术后随访2—72个月，除2例有间歇黑便外，其余患者无再出血。复查胃镜显示6例患者静脉曲张程度明显减轻，18例未检出曲张静脉。结论应根据胰腺炎及伴随的假性囊肿形成时间不同，选择MVBPAPH的处理方式。

Objective To study treatment of massive variceal bleeding secondary to localized pan- creatitis-associated portal hypertension （MVBPAPH）. Methods A retrospective study on the clinical data of patients with MVBPAPH was carried out. Of 24 patients with MVBPAPH, 20 had pancreatic pseudocysts. 12 were operated after failure of treatment with endovascular intervention for variceal bleeding （ including 10 patients with splenectomy and gastric fundus-body peripheral vessels amputation and 2 patients with pancrea- tic pseudocystogastrostomy）. 8 patients underwent partial splenic embolization and left gastroepiploic artery embolization. 4 patients directly underwent splenectomy and gastric fundus-body peripheral vessels amputa- tion for variceal bleeding. Results Left pleura1 effusion developed in 5 patients who underwent arterial em- bolization. Left pleural effusion and lung infection occurred in 2 patients who underwent operation. All pa- tients recovered well and were discharged home. During the follow-up period of 2 to 72 months, no reblee- ding occurred in these patients （ including 2 patients had passed little interval melena）. Gastroscopy re-exa- mination showed that variceal veins were not found in 18 patients. Variceal veins which were detected in the remaining 6 patients were obviously less severe. Conclusion Individualized treatment should be given to patients with MVBPAPH and according to the specific type of pancreatitis and the onset time of any accompa- nying pseudocyst.