摘要
目的探讨胰源性门脉高压症(pancreatic portal hypertension,PPH)的临床特点及治疗方法。方法回顾性分析2008年7月至2018年7月10年间在武汉大学人民医院住院的PPH患者。排除临床、影像学或实验室改变提示肝硬化的患者。记录患者的一般资料、临床表现、实验室检查结果、预后,进行相关因素分析。结果共32例患者纳入研究,男25例,女7例,年龄(57.3±10.2)岁。病因为:慢性胰腺炎(n=18)、胰腺癌(n=6)、胰腺囊肿(n=4)、急性胰腺炎(n=2)、胰腺手术(n=2)。临床表现为:无症状/非特异性腹部疼痛(n=20);上消化道出血(upper gastrointestinal bleeding,UGIB)(n=12)。所有患者均获随访(随访5个月~7年),其中所有患者均有胃和/或食管静脉曲张,7例(21.9%)患者有脾肿大,5例(15.6%)患者有血小板减少症。12例(37.5%)患者接受内镜治疗,8例(25.0%)患者接受脾动脉栓塞和/或脾切除术。4例(12.5%)患者死亡,3例死于胰腺癌复发,另1例死于与PPH无关的感染性并发症。其余患者预后良好。结论 PPH通常与胰腺疾病有关,急性或慢性胰腺炎是主要病因。大多数患者无症状,消化道出血和脾脏肿大是PPH最重要的临床表现,有胰腺病史合并UGIB的患者在临床上应考虑PPH,与胃食管周围的静脉回流受阻有关。对于大量UGIB而内镜手术失败者和/或脾脏肿大的患者,主张进行手术和/或血管内治疗。抗凝治疗不是必须的,应根据具体情况加以考虑。
Objective To explore the clinical characteristics and treatment of pancreatic portal hypertension(PPH). Methods PPH patients observed in inpatients in the Renmin Hospital of Wuhan University from Jul. 2008 to Jul. 2018 were analyzed retrospectively. Patients with cirrhosis were excluded by clinical, imaging or laboratory changes. The patients’ general information, clinical manifestations and laboratory test results, prognosis were recorded, and their related factors were analyzed. Results A total of 32 patients were included in the study during the study period(25 males, 7 females);mean age was(57.3±10.2) years old. Causes were chronic pancreatitis(n=18), pancreatic cancer(n=6), pancreas cyst(n=4), acute pancreatitis(n=2), pancreatic surgery(n=2). The clinical manifestations were: asymptomatic/nonspecific abdominal pain(n=20);upper gastrointestinal bleeding(UGIB)(n=12). All patients were followed up(5 months to 7 years of follow-up), all of whom had gastric and/or esophageal varices, 7 patients(21.7%) had splenomegaly, and 5 patients(15.6%) had thrombocytopenia. 12 patients(37.5%) received endoscopic therapy, 8 patients(25.0%) received splenic artery embolization and/or splenectomy. 4 patients(12.5%) had pancreatic cancer death, 3 patients died of pancreatic cancer recurrence, and another died of infectious complications not related to PPH. The remaining patients had a good prognosis. Conclusion PPH is usually associated with pancreatic disease, acute or chronic pancreatitis is the main cause. Most patients are asymptomatic, gastrointestinal bleeding and splenomegaly are the most important clinical manifestations of PPH. Patients with a history of pancreas and clinical symptoms of UGIB should be considered clinically PPH, the result of which is associated with venous reflux around the gastro-esophagus. Surgery and/or endovascular treatment is recommended, especially for patients with a large number of UGIB who have failed endoscopic surgery. However, conservative methods should be used in other cases. Anticoagulant therapy is not necessary and must be considered on a case-by-case basis.
作者
杨益波
余保平
YANG Yibo;YU Baoping(Department of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan 430060,China)
出处
《胃肠病学和肝病学杂志》
CAS
2020年第7期805-809,共5页
Chinese Journal of Gastroenterology and Hepatology
基金
国家自然科学基金(81770638)。
关键词
胰腺疾病
门脉高压症
脾脏肿大
消化道出血
Pancreatic disease
Portal hypertension
Splenomegaly
Gastrointestinal bleeding
