摘要
目的:探讨胰源性门静脉高压症的诊断方法和治疗措施。方法:回顾分析我院自1995年3月至2006年6月收治的胰源性门静脉高症症21例,均有胰腺炎病史,其中3例合并假性囊肿,1例合并胰尾部癌。10例有上消化道大出血。结果:16例行手术治疗。手术指征:胃底静脉重度曲张或伴有食道静脉曲张,既往有上消化道大出血史,以及门静脉主干有血栓形成。手术方法:脾切除是基本方法,胰周纤维化明显者联合胰体尾切除;假性囊肿行囊肿-空肠Roux-en-y式吻合;胰尾癌行胰体尾切除;有食管静脉曲张者附加贲门食管周围血管离断术;门静脉主干有血栓者行肠系膜上静脉-下腔静脉H型分流术。5例行非手术治疗。结论:胰源性门静脉高压症临床较为少见,其诊断和治疗有不同于肝硬化性门静脉高压症的特点,手术治疗效果良好。对于胃底静脉曲张较轻、无出血史者可非手术治疗,随着胰腺原发病的控制和血栓再通,胃底静脉曲张也可好转或停止发展。
Objective To explore the diagnosis and treatment of pancreatogenic portal hypertension. Methods A total of 21 patients with pancreatogenic portal hypertension admitted from March 1995 to June 2006 were reviewed. Of the series, 3 patients had a concurrent pancreatic pseudocyst, 1 patient complicated by pancreatic carcinoma, 10 patients complicated by concomitant upper gastrointestinal bleeding. Results Surgery was performed in 16 patients due to the history of upper gastrointestinal bleeding, severe esophago-gastric varices or thrombosis of the portal vein. Splenectomy was an essential part of the treatment, and distal pancreatectomy was performed with the presence of pancreatic fibrosis. Roux- en-y cystojejunostomy was performed in 3 patients with pancreatic pscudocysts, and the resection of pancreatic carcinoma was performed in 1 patient. Peri-esophgeal vascular devascularization（Hassab＇s operation） was performed in patients with esophageal varices. Portocaval H-graft was performed in 3 patients with thrombosis of portal vein. In 5 patients, the treatment was conservative. All the patients were followed up for 1-6 years and had good recovery after the treatment. Conclusions Pancreatogenic portal hypertension is seldom seen clinically. The diagnosis and treatment are somewhat particular as compared with portal hypertension in patients with cirrhosis of liver. The indications of surgery with pancreatogenie portal hypertension are the history of upper gastrointestinal bleeding, severe esophago-gastric varices and thrombsis of portal vein. Medical treatment is preferred for mild gastric varices.
出处
《外科理论与实践》
2008年第3期213-215,共3页
Journal of Surgery Concepts & Practice
基金
福建省自然科学基金(2006J0372)
关键词
高血压
门静脉
外科手术
诊断
胰腺炎
Hypertension, pertal
Surgery
Diagnosis
Pancreatitis
