胰源性门脉高压症临床诊治分析

目的 探讨胰源性门脉高压症的诊断和治疗方法,总结手术治疗经验,尤其是复杂病例和合并症的处理.方法 总结1990年1月至2006年11月收治的26例病例,行脾切除、胃底贲门周围血管离断术,并对复杂病例的术中应对措施和方法进行回顾性总结.其中7例合并胰腺囊肿者,因囊肿巨大、且不规则无法完整切除而行囊肿空肠Roux-en-Y 吻合;3例因胰腺炎后脾脏与膈肌粘连严重、界限不清,脾脏切除时首先行膈肌局部切开,解剖显露清晰后切除脾脏;2例胰腺肿瘤同时行胰腺体尾部肿瘤切除.结果 除1例术后5 d死于急性心肌梗死,25例获得临床治愈,随访2～15年(平均8年)无复发,无消化道出血.结论 脾脏切除、胃底贲门周围血管离断是治疗胰源性门脉高压症可靠的手术方法,正确诊断、同时处理胰腺原发性疾病及其并发症是治愈胰源性门脉高压的关键.

Diagnosis and treatment of pancreatogenic portal hypertension: analysis of 26 cases

OBJECTIVE: To investigate the diagnostic and treatment methods of pancreatogenic portal hypertension and to summarize the experience in surgical treatment of these patients, especially in dealing with the complications and sophisticated cases. METHODS: Twenty-six patients with pancreatogenic portal hypertension, 19 males and 7 females, aged 37 (29 - 57), underwent pericardial vessel ligation and splenectomy during the period from January 1990 to November 2006 and were followed up for 8 years (2 - 15 years). The clinical data were analyzed. RESULTS: Seven patients received Roux-en-Y operation for huge pancreatogenic cysts and 3 patients received regional dissection operation of diaphragmatic muscle for severe adhesion. One died of acute myocardial infarction 5 days after the operation, and 25 patients were cured without recurrence during the follow-up. CONCLUSION: Pericardial vessel ligation and splenectomy are rational and reliable methods to treat pancreatogenic portal hypertension. The key issue is how to diagnose pancreatogenic portal hypertension correctly and deal with its complications reasonably.