李萌, 刘迎娣, 孙国辉, 柴国君, 毛永平, 孙刚, 王娟, 杨竞, 申少华, 令狐恩强. 胰源性门脉高压症的诊治体会[J]. 解放军医学院学报, 2015, 36(12): 1201-1203,1207. DOI: 10.3969/j.issn.2095-5227.2015.12.011
引用本文: 李萌, 刘迎娣, 孙国辉, 柴国君, 毛永平, 孙刚, 王娟, 杨竞, 申少华, 令狐恩强. 胰源性门脉高压症的诊治体会[J]. 解放军医学院学报, 2015, 36(12): 1201-1203,1207. DOI: 10.3969/j.issn.2095-5227.2015.12.011
LI Meng, LIU Yingdi, SUN Guohui, CHAI Guojun, MAO Yongping, SUN Gang, WANG Juan, YANG Jing, SHEN Shaohua, LINGHU Enqiang. Diagnosis and treatment of pancreatogenic portal hypertension[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2015, 36(12): 1201-1203,1207. DOI: 10.3969/j.issn.2095-5227.2015.12.011
Citation: LI Meng, LIU Yingdi, SUN Guohui, CHAI Guojun, MAO Yongping, SUN Gang, WANG Juan, YANG Jing, SHEN Shaohua, LINGHU Enqiang. Diagnosis and treatment of pancreatogenic portal hypertension[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2015, 36(12): 1201-1203,1207. DOI: 10.3969/j.issn.2095-5227.2015.12.011

胰源性门脉高压症的诊治体会

Diagnosis and treatment of pancreatogenic portal hypertension

  • 摘要: 目的 探讨胰源性门脉高压症(pancreatic portal hypertension,PPH)的发病情况、病因、临床诊断及治疗。 方法 选择解放军总医院2009年5月- 2015年5月收治的PPH患者34例,回顾性分析病因、临床特征、内镜特点、诊断手段及治疗方法。 结果 诊断主要依赖内镜、超声和CT,34例中基础胰腺病因有胰腺癌4例,胰腺实性假乳头状瘤1例,胰腺囊肿4例,慢性胰腺炎20例,急性胰腺炎5例。31例有呕血和(或)黑粪史,其中1例有失血性休克表现。所有患者均无肝硬化、腹水及肝功能异常等表现,均有脾大。胃镜和超声胃镜提示胃底、食管静脉曲张34例。外科手术治疗10例,其余经内科保守治疗或内镜下组织胶注射治疗,好转后保持随访。患者手术后预后良好,均没有复发上消化道出血。1例胰腺癌死于肿瘤晚期。 结论 PPH具有孤立性胃底静脉曲张、脾大、无肝硬化、肝功能正常以及胰腺疾病病史等特征,结合内镜和多种影像学手段,能够较容易诊断出胰源性门静脉高压,须与肝源性门脉高压症区别,内镜联合内科保守治疗可控制急诊出血,采用综合治疗预后良好。

     

    Abstract: Objective To investigate the causes, clinical manifestations and treatment of pancreatogenic portal hypertension (PPH). Methods A retrospective analysis was carried out in 34 patients with portal hypertension complicating with pancreatic diseases in Chinese PLA General Hospital from May 2009 to May 2015. Medical records of these patients were reviewed, including demographics, etiologies, clinical manifestations, endoscopic classification, laboratory tests, imaging studies and treatment. Results The main diagnostic methods were endoscopy, ultrasonography (US) and computerized tomography (CT). Of the 34 cases, pancreatic cancer was found in 4 cases, solid pseudopapillary neoplasm of the pancreas in 1 case, pancreatic cyst in 4 cases, chronic pancreas in 20 cases, acute pancreas in 5 cases. Thirty-one patients presented with hematemesis or melena and one patient with hemorrhagic shock. All patients had no manifestations of cirrhosis, ascites and abnormal hepatic function, while splenomegaly was presented in all patients. Endoscopy and endoscopic ultrasound revealed that all patients had gastroesophageal varices. Ten patients underwent operation treatment, and the remaining cases received conservative treatment including endoscopic tissue adhesive injection. Follow-up was done after acute bleeding was controlled. No postoperative bleeding occurred in the period of follow-up.One case died of pancreatic cancer. Conclusion Isolated gastric varices, splenomegalia, liver function and a history of pancreatic disease are helpful in diagnosing PPH. Based on findings of endoscopy and other imaging methods, PHH can be diagnosed easily, however, it should have differential diagnosis with liver-derived portal hypertension. Endoscopic tissue adhesive injection can effectively control acute variceal bleeding. Right diagnosis and efficient management are the right points for therapy of PPH.

     

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