门静脉海绵样变62例临床特点分析

Analysis of clinical features of 62 patients with cavernous transformation of portal vein

目的探讨门静脉海绵样变患者的性别、年龄分布及病因、临床表现等临床特点。方法搜集河南省人民医院2012年1月至2014年12月共62例门脉海绵样变患者,对其病因、症状、体征、实验室检查、影像学表现、治疗方法等进行整理分析。结果患者年龄4~84岁,中位年龄46岁;男31例,女31例,年龄及性别分布基本均衡;常见的伴随疾病有肝硬化、肝癌、胆道结石、胆道肿瘤等,25例(40.3%)患者无明确基础疾病;常见临床表现有腹胀、腹痛、消化道出血、脾功能亢进、腹水等。诊断主要依据影像学,其多表现为门静脉主干及分支显示不清,闭锁或栓子形成,门静脉周围大量侧支血管形成。治疗主要以对症支持治疗为主;针对有脾功能亢进(27例)及消化道出血(16例),脾脏切除+断流术为主要手术方法,本组实施8例。结论门脉海绵样变是肝前型门脉高压症的重要病因,近年来该类病例临床发现不断增多,临床医师需加强对其的认识。

Objective To investigate the clinical features （such as gender, age, clinical manifestation and etc ） of cavernous transformation of portal vein （CTPV）. Methods A total of 62 patients with CTPV who received treatment at Henan Provincial People＇s Hospital from January 2012 to December 2014 was collected, and their etiology, symptoms, physical signs,laboratory examination, imaging findings and treatment methods were analyzed. Results There were 31 male and 31 female among the patients whose age ranged from 4 to 84 with a median age of 46. And gender and age distribution was balanced. The common associated diseases included liver cirrhosis, hepatic carcinoma, biliary calculi, biliary tract tumor and so on, and there were 25 cases of patients （40. 3% ） without definite underlying disease. The common clinical manifestations included abdominal distention, abdominal pain, gastrointestinal bleeding, hypersplenism, ascites, etc. The diagnosis was mainly based on imaging, which showed that the trunk and branches of the portal vein were unclear, atresia or embolus formed, and a large number of collateral vessels around the portal vein were formed. The symptomatic and supportive treatmentwas main therapeutic approach for CTPV. For the patients with hypersplenism （27 eases ） and gastrointestinal bleeding （16 cases ）, splenectomy with devascularization was the main surgery method, and there were 8 patients received this kind of surgery in this group. Conclusions CTPV is an important cause of prehepatic portal hypertension. In recent years, the clinical findings of CTPV have been increasing, and clinicians need to strengthen their understanding of CTPV.