胰源性门静脉高压症伴上消化道出血的诊治

目的总结胰源性门静脉高压症伴上消化道出血的诊治经验。方法回顾性分析2000～2004年我院诊治的28例胰源性门静脉高压症(其中9例合并上消化道出血)患者的病因、临床表现和诊治方法。结果28例胰源性门静脉高压症患者的病因分别为急性胰腺炎(7例)、慢性胰腺炎(13例)和胰腺肿瘤(8例);9例合并上消化道出血中分别为1例、5例和3例,表现为反复呕血、血便/黑便,伴有出血性休克,平均单次出血量>1000ml。诊断主要依靠超声、CT和内镜,彩色Doppler可以发现脾静脉主干栓塞,增强CT可以明确胃底周围静脉扩张和/或脾静脉主干栓塞,胃镜检查显示主要为孤立性胃底静脉曲张。消化道出血患者中3例行内镜下硬化治疗,成功1例;7例脾脏切除后成功止血。结论对于胰源性门静脉高压症若无出血症状,只需治疗原发疾病;脾脏切除术是胰源性门静脉高压症合并消化道出血的确切治疗措施,内镜硬化治疗效果欠佳。

The Diagnosis and Management of Upper Gastrointestinal Bleeding Due to Pancreatogenic Portal Hypertension

Objective To summarize the experience of the diagnosis and treatment of upper gastrointestinal bleeding due to portal hypertension complicating pancreatic diseases.Methods 28 patients with portal hypertension complicating pancreatic diseases were reviewed from 2000 to 2004,9 patients of which complicated with upper gastrointestinal bleeding.The etiology,clinical manifestation,diagnostic and therapeutic methods were analyzed retrospectively.Results The etiology of portal hypertension included acute pancreatitis(7 cases),chronic pancreatitis(13 cases) and pancreatic tumor(8 cases).The etiology of 9 cases with upper gastrointestinal bleeding included acute pancreatitis(1 case),chronic pancreatitis and pancreatic tumors(5 cases),the clinical manifestations were repeated hematemesis,hemafecia or melena,along with hemorrhagic shock,the average bleeding volume exceeded 1000ml.The diagnosis mainly depended on ultrasonography,computerized tomography (CT) and endoscopy.Splenic vein thrombosis could be indicated by color Doppler ultrasonography,the enhanced CT could demonstrated the varices around gastric fundus and/or splenic vein thrombosis,and the isolated gastric varices couldbe revealed mostly by gastroscopy.3 cases with upper gastrointestinal bleeding were formed by endoscopic sclerotherapy,one of which succeeded;7 cases undergoing splenectomy all had no more gastrointestinal bleeding.Conclusion For patients with portal hypertension complicating pancreatic diseases but without the symptoms of gastrointestinal bleeding,the treatment should be focused on the primary disease.Splenectomy is an accurate treatment for those with gastrointestinal bleeding,endoscopic sclerotherapy is not recommended.