贲门周围血管离断术后异位曲张静脉破裂出血的诊治经验(附12例报告)

Dagnosis and treatment experience of ectopic variceal hemorrhage after pericardial devascularization: a report of 12 cases

目的总结贲门周围血管离断术后异位曲张静脉破裂出血(pericardial devascularization ectopic variceal hemorrhage,PDEV)的临床特征及诊治经验。方法收集2010年10月～2018年3月诊治及门诊随访的PDEV病人12例,对其临床资料进行回顾性分析并结合文献进行复习。结果 12例病人中乙型肝炎肝硬化9例,酒精性肝硬化伴门静脉主干血栓阻塞2例,布-加综合征1例。再次出血距贲门周围血管离断术的平均时间间隔为(3.6±1.4)年。12例病人经数字减影血管造影(DSA)确诊4例,小肠镜检查确诊8例。术中发现空肠屈氏韧带下方20 cm处的起始部有异位曲张静脉9例,胃冠状静脉右侧有孤立性的异位曲张静脉延至十二指肠降部3例。术后11例病人再无上消化道出血史,1例病人出现门静脉高压性胃病,治疗后获得好转。结论对于异位曲张静脉破裂出血,DSA和小肠镜是必不可少的检查手段,外科手术是最佳治疗手段。贲门周围血管离断术后异位静脉曲张破裂出血值得重视,及时有效的治疗可改善预后。

Objective To investigate the clinical characteristics and how to diagnose and treat ectopic variceal hemorrhage after pericardial devascularization. Methods The clinical data of 12 patients with bleeding after pericardial devascularization were summarized and they were followed-up from October2010 to March 2018. The clinical data were retrospectively analyzed and reviewed in conjunction with the literature. Results Among all the 12 patients,9 patients suffered cirrhotic portal hypertension with hepatitis B,2 patients were main portal vein obstruction with thrombosis accompanied alcoholic cirrhosis,1 patients with Budd-Chiari syndrome. The average interval duration between rebleeding and pericardial devascularization was（ 3. 6 ± 1. 4） years. Among 12 patients,4 patients were diagnosed by DSA and 8 patients were diagnosed by small intestinal endoscope. During the operation,9 patients were found ectopic varicose veins in the jejunum（ 20 cm below the Treitz ligament） and 3 patients were found that there existed isolated ectopic varicose vein extending to the descending segment of duodenum on the right side of the gastric coronary vein. 11 patients had no history of upper gastrointestinal bleeding,and 1 patient developed portal hypertensive gastropathy,which turned better after treatment. Conclusion DSA and small intestinal endoscope are indispensable for ectopic variceal hemorrhage,however surgery is the best treatment. The ectopic variceal hemorrhage after pericardial devascularization should gain our great attention,and timely and effective treatment can obviously improve the prognosis.