Progress in the treatment of pancreatic sinistral portal hypertension_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

REN Jiaqiang , WU Shuai , HAN Liang ,  WU Zheng

Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, P. R. China;

Corresponding author：

WU Zheng, Email: woozheng@xjtu.edu.cn

Keywords：

pancreatic sinistral portal hypertension; gastric varicose vein; splenectomy; primary disease of pancreas; pancreatic surgery

DOI：

10.7507/1007-9424.202204046

Video：

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Pancreatic sinistral portal hypertension (PSPH) is a clinical syndrome resulting from pancreatic disease that blocks splenic vein return, which includes acute and chronic pancreatitis, pancreatic tumors, and iatrogenic factors related to pancreatic surgery. Most PSPH patients present with isolated gastric varices, splenomegaly and hypersplenism, with normal liver function, and upper gastrointestinal bleeding caused by varices in the fundus of the stomach is the most serious clinical manifestation. The treatment of PSPH can be divided into the treatment of portal hypertension in the spleen and stomach region, including close follow-up, medication, endoscopic therapy, splenic artery embolization and splenectomy, etc. The primary diseases of pancreas are mainly treated for acute pancreatitis, chronic pancreatitis and pancreatic tumor. In particular, PSPH related to pancreatic surgery should be concerned.

Citation： REN Jiaqiang, WU Shuai, HAN Liang, WU Zheng. Progress in the treatment of pancreatic sinistral portal hypertension. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(8): 992-996. doi: 10.7507/1007-9424.202204046 Copy

1.	赵玉沛, 李晓斌, 李宏为, 等. 胰源性门静脉高压症诊治规范 (草案). 中华普通外科杂志, 2013, 28(5): 405-406.
2.	Madsen MS, Petersen TH, Sommer H. Segmental portal hypertension. Ann Surg, 1986, 204(1): 72-77.
3.	Greenwald HM, Wasch MG. The roentgenologic demonstration of esophageal varices as a diagnostic aid in chronic thrombosis of the splenic vein. J Pediatr, 1939, 14: 57-65.
4.	Sakorafas GH, Sarr MG, Farley DR, et al. The significance of sinistral portal hypertension complicating chronic pancreatitis. Am J Surg, 2000, 179(2): 129-133.
5.	Kokabi N, Lee E, Echevarria C, et al. Sinistral portal hypertension: presentation, radiological findings, and treatment options - a case report. J Radiol Case Rep, 2010, 4(10): 14-20.
6.	Thompson RJ, Taylor MA, Mckie LD, et al. Sinistral portal hypertension. Ulster Med J, 2006, 75(3): 175-177.
7.	Mier-Hicks A, Raj M, Do RK, et al. Incidence, management, and implications of visceral thrombosis in pancreatic ductal adenocarcinoma. Clin Colorectal Cancer, 2018, 17(2): 121-128.
8.	Petrucciani N, Debs T, Rosso E, et al. Left-sided portal hypertension after pancreatoduodenectomy with resection of the portal/superior mesenteric vein confluence. Results of a systematic review. Surgery, 2020, 168(3): 434-439.
9.	陈光文, 刘曦娇, 宋彬. 肝、胰源性门静脉高压侧支循环开放情况的对比研究. 中国普外基础与临床杂志, 2018, 25(5): 622-628.
10.	王烁, 卿笃信. 区域性门静脉高压26例的诊治. 中华肝脏病杂志, 2020, 28(6): 515-517.
11.	向兴华, 李文斌, 成伟, 等. 代偿的胃网膜静脉降低胰源性门静脉高压症胃静脉破裂出血. 肝胆胰外科杂志, 2022, 34(1): 43-45.
12.	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.
13.	Fernandes A, Almeida N, Ferreira AM, et al. Left-sided portal hypertension: a sinister entity. GE Port J Gastroenterol, 2015, 22(6): 234-239.
14.	Ru N, He CH, Ren XL, et al. Risk factors for sinistral portal hypertension and related variceal bleeding in patients with chronic pancreatitis. J Dig Dis, 2020, 21(8): 468-474.
15.	Köklü S, Coban S, Yüksel O, et al. Left-sided portal hypertension. Dig Dis Sci, 2007, 52(5): 1141-1149.
16.	朱军, 徐晓茜, 罗剑钧, 等. 经皮脾静脉成形术治疗胰源性门静脉高压症. 介入放射学杂志, 2018, 27(5): 415-418.
17.	Wang Q, Xiong B, Zheng C, et al. Splenic arterial embolization in the treatment of severe portal hypertension due to pancreatic diseases: the primary experience in 14 patients. Cardiovasc Intervent Radiol, 2016, 39(3): 353-358.
18.	Andersson R, Löhr JM, Working Group for Chronic Pancreatitis Guidelines (Sweden). Swedish national guidelines for chronic pancreatitis. Scand J Gastroenterol, 2021, 56(4): 469-483.
19.	Loftus JP, Nagorney DM, Ilstrup D, et al. Sinistral portal hypertension. Splenectomy or expectant management. Ann Surg, 1993, 217(1): 35-40.
20.	宋海宇, 谭清泉, 陈拥华, 等. 胰腺炎后胰源性门静脉高压患者术中大出血的危险因素探究. 中国普外基础与临床杂志, 2019, 26(5): 557-562.
21.	李昂芝, 李懋, 熊俊杰, 等. 联合脾动脉栓塞术治疗外科术中高出血风险的胰源性门脉高压—前瞻性非随机对照研究. 临床急诊杂志, 2021, 22(3): 168-171.
22.	Tanaka M, Ito H, Ono Y, et al. Impact of portal vein resection with splenic vein reconstruction after pancreatoduodenectomy on sinistral portal hypertension: Who needs reconstruction? Surgery, 2019, 165(2): 291-297.
23.	Yu X, Bai X, Li Q, et al. Role of collateral venous circulation in prevention of sinistral portal hypertension after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy: a single-center experience. J Gastrointest Surg, 2020, 24(9): 2054-2061.
24.	Ono Y, Takahashi Y, Tanaka M, et al. Sinistral portal hypertension prediction during pancreatoduodenectomy with splenic vein resection. J Surg Res, 2021, 259: 509-515.
25.	Zhang X, Wu Q, Fan H, et al. Reconstructing spleno-mesenterico-portal cofluence by bifurcated allogeneic vein in local advanced pancreatic cancer-a feasible method to avoid left-sided portal hypertension. Cancer Med, 2021, 10(16): 5448-5455.
26.	Ferrone CR, Konstantinidis IT, Sahani DV, et al. Twenty-three years of the Warshaw operation for distal pancreatectomy with preservation of the spleen. Ann Surg, 2011, 253(6): 1136-1139.
27.	Song J, He Z, Ma S, et al. Clinical comparison of spleen-preserving distal pancreatectomy with or without splenic vessel preservation: A systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A, 2019, 29(3): 323-332.
28.	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.
29.	Desaki R, Mizuno S, Tanemura A, et al. A new surgical technique of pancreaticoduodenectomy with splenic artery resection for ductal adenocarcinoma of the pancreatic head and/or body invading splenic artery: impact of the balance between surgical radicality and QOL to avoid total pancreatectomy. Biomed Res Int, 2014, 2014: 219038. doi: 10.1155/2014/219038.

1. 赵玉沛, 李晓斌, 李宏为, 等. 胰源性门静脉高压症诊治规范 (草案). 中华普通外科杂志, 2013, 28(5): 405-406.
2. Madsen MS, Petersen TH, Sommer H. Segmental portal hypertension. Ann Surg, 1986, 204(1): 72-77.
3. Greenwald HM, Wasch MG. The roentgenologic demonstration of esophageal varices as a diagnostic aid in chronic thrombosis of the splenic vein. J Pediatr, 1939, 14: 57-65.
4. Sakorafas GH, Sarr MG, Farley DR, et al. The significance of sinistral portal hypertension complicating chronic pancreatitis. Am J Surg, 2000, 179(2): 129-133.
5. Kokabi N, Lee E, Echevarria C, et al. Sinistral portal hypertension: presentation, radiological findings, and treatment options - a case report. J Radiol Case Rep, 2010, 4(10): 14-20.
6. Thompson RJ, Taylor MA, Mckie LD, et al. Sinistral portal hypertension. Ulster Med J, 2006, 75(3): 175-177.
7. Mier-Hicks A, Raj M, Do RK, et al. Incidence, management, and implications of visceral thrombosis in pancreatic ductal adenocarcinoma. Clin Colorectal Cancer, 2018, 17(2): 121-128.
8. Petrucciani N, Debs T, Rosso E, et al. Left-sided portal hypertension after pancreatoduodenectomy with resection of the portal/superior mesenteric vein confluence. Results of a systematic review. Surgery, 2020, 168(3): 434-439.
9. 陈光文, 刘曦娇, 宋彬. 肝、胰源性门静脉高压侧支循环开放情况的对比研究. 中国普外基础与临床杂志, 2018, 25(5): 622-628.
10. 王烁, 卿笃信. 区域性门静脉高压26例的诊治. 中华肝脏病杂志, 2020, 28(6): 515-517.
11. 向兴华, 李文斌, 成伟, 等. 代偿的胃网膜静脉降低胰源性门静脉高压症胃静脉破裂出血. 肝胆胰外科杂志, 2022, 34(1): 43-45.
12. 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.
13. Fernandes A, Almeida N, Ferreira AM, et al. Left-sided portal hypertension: a sinister entity. GE Port J Gastroenterol, 2015, 22(6): 234-239.
14. Ru N, He CH, Ren XL, et al. Risk factors for sinistral portal hypertension and related variceal bleeding in patients with chronic pancreatitis. J Dig Dis, 2020, 21(8): 468-474.
15. Köklü S, Coban S, Yüksel O, et al. Left-sided portal hypertension. Dig Dis Sci, 2007, 52(5): 1141-1149.
16. 朱军, 徐晓茜, 罗剑钧, 等. 经皮脾静脉成形术治疗胰源性门静脉高压症. 介入放射学杂志, 2018, 27(5): 415-418.
17. Wang Q, Xiong B, Zheng C, et al. Splenic arterial embolization in the treatment of severe portal hypertension due to pancreatic diseases: the primary experience in 14 patients. Cardiovasc Intervent Radiol, 2016, 39(3): 353-358.
18. Andersson R, Löhr JM, Working Group for Chronic Pancreatitis Guidelines (Sweden). Swedish national guidelines for chronic pancreatitis. Scand J Gastroenterol, 2021, 56(4): 469-483.
19. Loftus JP, Nagorney DM, Ilstrup D, et al. Sinistral portal hypertension. Splenectomy or expectant management. Ann Surg, 1993, 217(1): 35-40.
20. 宋海宇, 谭清泉, 陈拥华, 等. 胰腺炎后胰源性门静脉高压患者术中大出血的危险因素探究. 中国普外基础与临床杂志, 2019, 26(5): 557-562.
21. 李昂芝, 李懋, 熊俊杰, 等. 联合脾动脉栓塞术治疗外科术中高出血风险的胰源性门脉高压—前瞻性非随机对照研究. 临床急诊杂志, 2021, 22(3): 168-171.
22. Tanaka M, Ito H, Ono Y, et al. Impact of portal vein resection with splenic vein reconstruction after pancreatoduodenectomy on sinistral portal hypertension: Who needs reconstruction? Surgery, 2019, 165(2): 291-297.
23. Yu X, Bai X, Li Q, et al. Role of collateral venous circulation in prevention of sinistral portal hypertension after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy: a single-center experience. J Gastrointest Surg, 2020, 24(9): 2054-2061.
24. Ono Y, Takahashi Y, Tanaka M, et al. Sinistral portal hypertension prediction during pancreatoduodenectomy with splenic vein resection. J Surg Res, 2021, 259: 509-515.
25. Zhang X, Wu Q, Fan H, et al. Reconstructing spleno-mesenterico-portal cofluence by bifurcated allogeneic vein in local advanced pancreatic cancer-a feasible method to avoid left-sided portal hypertension. Cancer Med, 2021, 10(16): 5448-5455.
26. Ferrone CR, Konstantinidis IT, Sahani DV, et al. Twenty-three years of the Warshaw operation for distal pancreatectomy with preservation of the spleen. Ann Surg, 2011, 253(6): 1136-1139.
27. Song J, He Z, Ma S, et al. Clinical comparison of spleen-preserving distal pancreatectomy with or without splenic vessel preservation: A systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A, 2019, 29(3): 323-332.
28. 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.
29. Desaki R, Mizuno S, Tanemura A, et al. A new surgical technique of pancreaticoduodenectomy with splenic artery resection for ductal adenocarcinoma of the pancreatic head and/or body invading splenic artery: impact of the balance between surgical radicality and QOL to avoid total pancreatectomy. Biomed Res Int, 2014, 2014: 219038. doi: 10.1155/2014/219038.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress in the treatment of pancreatic sinistral portal hypertension

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