【摘要】 目的探讨胰源性左侧门静脉高压症(PSPH)的诊断及治疗方法。方法回顾性分析作者医院自2000年1月至2004年12月收治的15例PSPH及复习国内近10年报道的52例PSPH的临床资料。结果诊断方法主要为超声、CT、MRA(磁共振三维重建血管造影)、胃镜及腹腔动脉造影。8例(8/67)行单纯脾切除术,23例(23/67)行单纯脾切除+胰腺原发病治疗,13例(13/67)行脾切除+贲门周围血管离断术,21例(21/67)行脾切除+贲门周围血管离断+胰腺原发病治疗,2例(2/67)行脾动脉栓塞+曲张出血静脉硬化术。术后随访率89.6%(60/67),随访12～53个月,平均33.1个月。1例行单纯脾切除未断流者于术后13个月出现呕血,余59例病例术后均无再出血发生。结论胰源性左侧门静脉高压症的治疗应遵循“个体化原则”。对于无上消化道出血病史者,可行单纯脾切除术;对于有出血病史者应根据具体情况,可采取脾切除+贲门周围血管离断术、脾动脉栓塞术、内镜下曲张静脉硬化等方法,并且应同时重视对胰腺原发病的治疗。更多还原

【Abstract】 Objective To investigate the diagnosis and treatment of pancreatic sinistral portal hypertension (PSPH).Methods 15 cases of PSPH treated in our hospital from Jan 2000 to Dec 2004 and 52 cases reported in the last 10 years in domestic literature were analyzed retrospectively.Results PSPH was diagnosed mainly by ultrasonography (US),computerized tomography(CT),magnetic resonance angiography (MRA),endoscopy and celiac arteriography.All the patients underwent surgery, including splenectomy in 8 cases(8/67);splenectomy + management of primary pancreatic disease in 23 cases(23/67);splenectomy +pericardial devascularization in 13 cases(13/67);splenectomy+pericardial devascularization+management of primary pancreatic disease in 21 cases(21/67)and splenic artery embolization+varices veins phlebosclerosis in 2 cases(2/67).The postoperative follow-up rate was 89.6%(60/67)and follow-up duration ranged from 12 months to 53 months,average 33.1 months.Haematemesis in one case of splenectomy without pericardial devascularization occurred at the 13th month postoperatively.No rehaemorrhagia occurred in the other 59 cases.Conclusion Therapeutic options of PSPH should abide by “individualized principle”.The simple splenectomy refer to the patients without upper gastrointestinal hemorrhage;For patients with upper gastrointestinal hemorrhage,appropriate therapeutic methods should be selected according to the specific circumstance,including splenectomy+pericardial devascularization,splenic artery embolization,varices phlebosclerosis,et al.Meanwhile,the management of primary pancreatic disease should also be emphasized.更多还原