区域性门静脉高压症的诊断与治疗.docVIP

区域性门静脉高压症的诊断与治疗 　　作者：张谊，张启瑜，廖毅 作者单位：(温州医学院第一附属医院 肝胆外科，浙江 温州 325000) 　　【摘要】 目的 探讨区域性门静脉高压症(regional portal hypertension，RPH)的病因、临床特点和诊治方法。方法 综合分析323例RPH患者的临床资料，其中我院7例，国内文献报道316例。结果 患者男女比例为2∶1，平均年龄45.7岁。胰源性疾病是主要病因，占87.3%。临床表现为脾肿大占100%、不规则上腹部疼痛占66.9%、上消化道出血占53.6%、肝功能检查均正常。B超、CT、MR可提示脾静脉主干栓塞或狭窄，脾门周围及胃短静脉、胃网膜静脉扩张迂曲及原发疾病。86.8%(198/228)的患者内镜检查示孤立性胃底静脉曲张。271例行手术治疗预后良好，32例保守治疗，成功26例。结论 RPH通常伴有胰腺疾病、脾功能亢进，但肝功能正常，而孤立性胃底静脉曲张是RPH最具特征性的表现。RPH是一种能够治愈的疾病，行病灶切除加脾切除疗效较好，伴有曲张静脉破裂出血者宜行贲门周围血管离断术。 　　【关键词】 高血压，门静脉，脾静脉，区域性，胃底静脉曲张，脾切除 　　Diagnosis and treatment of regional portal hypertension 　　ZHANG Yi， ZHANG Qiyu， LIAO YI. Department of Hepatobiliary Surgery， the First Affiliated Hospital of Wenzhou Medical College， Wenzhou 325000 　　Abstract Objective To explore the etiology， clinical characteristics， diagnosis and treatment of regional portal hypertension (RPH). Methods Clinical data of 323 cases with RPH， including 7 cases in our hospital and 316 cases reported in Chinese literatures from January 2000 to March 2008 were analyzed retrospectively. Results The male to female ratio was 2∶1. The mean age was 45.7 years. 87.3% cases resulted from pancreatic disease. The main clinical manifestations included splenomegaly 100%， abdominal pain 66.9% and the upper digestive tract bleeding 53.6%. All had normal liver function test. US， CT and MR could suggest splenic vein thrombosis or stricture， enlarged and tortuous of the short gastric veins， gastroepiploic veins， collateral vessels around splenic hilum， and primary disease. Isolated gastric varices was revealed in 86.8%(198/228) by gastroscopy. 271 cases underwent surgical treatment. 32 cases received conservative treatment. 26 cases of them recoverd. Conclusion RPH usually accompanies with pancreatic disease， hypersplenism but liver function is normal. Isolated gastric varices is the important evidence of RPH. It is a kind of disease to be cured by surgery. To resect nidus adding splenectomy will make good results， devascul