成人门静脉海绵样变性的诊断和治疗

目的　探讨成人门静脉海绵样变性的诊断方法和治疗。方法　对 31例成人门静脉海绵样变性患者的临床资料进行回顾性分析。结果　 31例患者术前均有出血史 ,术前均经超声检查提示肝脏正常及门静脉海绵样变性 ,经脾穿刺门静脉造影或选择性肠系膜上动脉造影确诊。 12例行脾动脉结扎、胃冠状静脉及分支结扎、肠 腔C型架桥术 ,1例行脾 肾静脉架桥术。 8例已切脾断流后再出血患者 ,结扎冠状静脉主干后 ,6例行肠 腔C型架桥术 ,1例行肠系膜下静脉 下腔静脉C型架桥术 ,1例因静脉曲张和出血部位在空肠上段而行空肠节段切除术。 6例行脾 腔架桥术 ,2例行改良脾 肺固定术 ,脾 肾架桥术和门静脉 下腔静脉架桥术各 1例 ,1例行脾切除加贲门周围血管离断术。术后随访 6个月～ 4年 (随访率 10 0 % ) ,食管胃底曲张静脉均减轻或消失 ,无再出血和肝性脑病发生。结论　多普勒超声检查和经皮脾穿刺门静脉造影是诊断本病的理想方法 ;门 体分流术加门 奇断流术是治疗本病的最佳选择。

Diagnosis and treatment of portal hypertension caused by cavernous transformation of the portal vein in adults

Objective To investigate the diagnosis and treatment of portal hypertension caused by cavernous transformation of the portal vein (CTPV) in adults Methods A retrospective study was made on clinical data of 31 adult upper GI bleeding patients with CTPV The diagnosis of CTPV in all cases were confirmed by B ultrasonography or ultrasonic Doppler and by percutaneous splenoportography or selective arteriography Splenic artery and coronary vein ligation plus C graft mesocaval shunt was performed in 12 cases Splenorenal graft shunt was performed in 1 In 8 post splenectomy rebleeding, cases 6 underwent C graft mesocaval shunt, one inferior meso caval shunt and one jejunectomy due to ictopic variceal hemorrhage Six cases received splenocaval shunt 2 splenopneumopexy 1 splenorenal shunt 1 portocaval shunt 1 pericardial devascularization ResultsPostoperativelly varices disappeared or ameliorated in all patients There was no rebleeding and hepatoencephalopathy occurred in follow up of 6 months to 4 years Conclusion Ultrasonic Doppler and percutaneous splenoportography are diagnostic for CTPV in adults Portasystemic shunt plus porta azygous devascularization is the choice of treatment