胰源性门静脉高压症21例诊治经验.pdfVIP

外科理论与实践2008年第 13卷第3期 · 论 著 · 胰源性门静脉高压症21例诊治经验 王 烈， 王 瑜， 姚和祥， 陈少全， 邹忠东 (南京军区福州总医院普通外科，福建 福州 350025) 【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；假性囊肿行囊肿一空肠 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 肠系膜上静脉一下腔静脉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。 关键词：高血压．门静脉； 外科手术； 诊断： 胰腺炎 中图分类号：R657．3+4 文献识别码：A 文章编号：1007—9610(20o8)03．0213-03 Experience in the diagnosis and treatment of pancreatogenic portal hypertension：An analysis of 21 cases WA NG Lie，WANG Yu,YA0 He—xiang,CHEN Shao—quart，ZOU Zhong-dong．Department of General Surgery,Fuzhou General Hospital of ．Fuzhou 350025,China [Abstract] 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 cyst0jejunostomy was performed in 3 patients with pancreatic pscudocysts， and the resection of pancreatic carci