胰源性门静脉高压症并上消化道出血的诊治体会_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

赵欣 ,  雷泽华 , 高峰畏 , 乌建平 , 付金强 , 杜波 , 王志旭 , 蒋康怡 , 谢青云

乐山市人民医院肝胆胰脾外科（四川乐山 614000）;

Corresponding author：

雷泽华, Email: leitsehua@126.com

Keywords：

门静脉高压症; 胰源性; 上消化道出血; 脾切除

DOI：

10.7507/1007-9424.201809055

Video：

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目的探讨胰源性门静脉高压症并上消化道出血的诊断及治疗方式。方法回顾性分析 2014 年6 月至 2018 年 6 月期间笔者所在医院诊治的 13 例胰源性门静脉高压症并上消化道出血患者的临床资料。结果 2 例早期行内镜下治疗，因再发上消化道出血行手术治疗；11 例早期明确诊断后行手术治疗。所有行手术治疗的患者术后恢复顺利，无并发症发生。术后均获访，随访时间 6～24 个月，中位数为 18 个月，随访期间无患者死亡及失访病例，未再发消化道出血等并发症。定期复查胃镜及腹部 CT 检查，曲张胃底静脉情况明显改善。结论对胰源性门静脉高压症并上消化道出血患者，早期明确诊断是关键，应选择针对胰腺疾病的相应手术治疗方案。脾切除术联合胃底血管离断术是治疗胰源性门静脉高压症并上消化道出血的有效手术方式。

Citation： 赵欣, 雷泽华, 高峰畏, 乌建平, 付金强, 杜波, 王志旭, 蒋康怡, 谢青云. 胰源性门静脉高压症并上消化道出血的诊治体会. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(3): 348-350. doi: 10.7507/1007-9424.201809055 Copy

1.	李晓斌, 廖泉, 赵玉沛. 区域性门静脉高压症的治疗策略. 中国普外基础与临床杂志, 2015, 22(11): 1300-1301.
2.	Gyoten K, Mizuno S, Nagata M, et al. Significance of simultaneous splenic artery resection in left-sided portal hypertension after pancreaticoduodenectomy with combined portal vein resection. World J Surg, 2017, 41(8): 2111-2120.
3.	Lu HM, Lu S, Zhang L, et al. Left-sided portal hypertension associated with acute pancreatitis treated by splenectomy : clinical characteristics and outcomes in a cohort of 79 cases. Pancreatology, 2017, 17(4): S60.
4.	倪晓凌, 顾大镛, 胡国华. 胰源性左侧门脉高压症的外科治疗及文献复习. 中华肝胆外科杂志, 2015, 21(5): 342-343.
5.	Piero C, Luca S, Mario C, et al. Severe intestinal bleeding due to left-sided portal hypertension after pancreatoduodenectomy with portal resection and splenic vein ligation. MOJ Tumor Res, 2017, 1(1): 1-3.
6.	Chen BC, Wang HH, Lin YC, et al. Isolated gastric variceal bleeding caused by splenic lymphoma-associated splenic vein occlusion. World J Gastroenterol, 2013, 19(40): 6939-6942.
7.	Barge JU, Lopera JE. Vascular complications of pancreatitis: role of interventional therapy. Korean J Radiol, 2012, 13 Suppl 1: S45-S55.
8.	王晓伟. 介入治疗老年胰源性门脉高压症患者并发消化道出血的临床价值. 世界华人消化杂志, 2018, 26(6): 401-405.
9.	卢山, 陆慧敏, 张凌, 等. 胰腺假性囊肿致左侧门静脉高压伴脾脏功能亢进的处理策略探讨. 中国普外基础与临床杂志, 2018, 25(5): 553-558.
10.	柳健, 谭诗云, 李明. 左侧门脉高压症的临床及超声内镜特征分析. 广西医学, 2017, 39(1): 78-80.
11.	汤善宏, 范泉水. 内镜下组织胶注射治疗区域性门静脉高压致胃底静脉曲张出血的疗效分析. 临床肝胆病杂志, 2015, 31(8): 1283-1286.
12.	Gandini R, Merolla S, Chegai F, et al. Trans-splenic embolization plus partial splenic embolization for management of variceal bleeding due to left-sided portal hypertension. Dig Dis Sci, 2018, 63(1): 264-267.
13.	Cortes A, Kim J, Commander C, et al. Splenic artery embolization for the treatment of gastric variceal bleeding secondary to splenic vein thrombosis. J Vas Interventional Rad, 2018, 29(4): S13-S14.
14.	Butler JR, Eckert GJ, Zyromski NJ, et al. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford), 2011, 13(12): 839-845.
15.	王要轩, 姜青峰, 李珂, 等. 胰源性门静脉高压 37 例临床分析. 中华肝胆外科杂志, 2017, 23(2): 114-116.

1. 李晓斌, 廖泉, 赵玉沛. 区域性门静脉高压症的治疗策略. 中国普外基础与临床杂志, 2015, 22(11): 1300-1301.
2. Gyoten K, Mizuno S, Nagata M, et al. Significance of simultaneous splenic artery resection in left-sided portal hypertension after pancreaticoduodenectomy with combined portal vein resection. World J Surg, 2017, 41(8): 2111-2120.
3. Lu HM, Lu S, Zhang L, et al. Left-sided portal hypertension associated with acute pancreatitis treated by splenectomy : clinical characteristics and outcomes in a cohort of 79 cases. Pancreatology, 2017, 17(4): S60.
4. 倪晓凌, 顾大镛, 胡国华. 胰源性左侧门脉高压症的外科治疗及文献复习. 中华肝胆外科杂志, 2015, 21(5): 342-343.
5. Piero C, Luca S, Mario C, et al. Severe intestinal bleeding due to left-sided portal hypertension after pancreatoduodenectomy with portal resection and splenic vein ligation. MOJ Tumor Res, 2017, 1(1): 1-3.
6. Chen BC, Wang HH, Lin YC, et al. Isolated gastric variceal bleeding caused by splenic lymphoma-associated splenic vein occlusion. World J Gastroenterol, 2013, 19(40): 6939-6942.
7. Barge JU, Lopera JE. Vascular complications of pancreatitis: role of interventional therapy. Korean J Radiol, 2012, 13 Suppl 1: S45-S55.
8. 王晓伟. 介入治疗老年胰源性门脉高压症患者并发消化道出血的临床价值. 世界华人消化杂志, 2018, 26(6): 401-405.
9. 卢山, 陆慧敏, 张凌, 等. 胰腺假性囊肿致左侧门静脉高压伴脾脏功能亢进的处理策略探讨. 中国普外基础与临床杂志, 2018, 25(5): 553-558.
10. 柳健, 谭诗云, 李明. 左侧门脉高压症的临床及超声内镜特征分析. 广西医学, 2017, 39(1): 78-80.
11. 汤善宏, 范泉水. 内镜下组织胶注射治疗区域性门静脉高压致胃底静脉曲张出血的疗效分析. 临床肝胆病杂志, 2015, 31(8): 1283-1286.
12. Gandini R, Merolla S, Chegai F, et al. Trans-splenic embolization plus partial splenic embolization for management of variceal bleeding due to left-sided portal hypertension. Dig Dis Sci, 2018, 63(1): 264-267.
13. Cortes A, Kim J, Commander C, et al. Splenic artery embolization for the treatment of gastric variceal bleeding secondary to splenic vein thrombosis. J Vas Interventional Rad, 2018, 29(4): S13-S14.
14. Butler JR, Eckert GJ, Zyromski NJ, et al. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford), 2011, 13(12): 839-845.
15. 王要轩, 姜青峰, 李珂, 等. 胰源性门静脉高压 37 例临床分析. 中华肝胆外科杂志, 2017, 23(2): 114-116.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

胰源性门静脉高压症并上消化道出血的诊治体会

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