伴区域性门静脉高压的左上腹恶性肿瘤的手术治疗

目的 探讨左上腹恶性肿瘤所致的区域性门静脉高压的病因、临床特点和治疗方法.方法 回顾性分析2006年1月至2009年12月上海交通大学医学院附属瑞金医院收治该类肿瘤源性区域性门静脉高压8例患者的临床资料.结果 本组8例患者中胰源性肿瘤5例,腹膜后肿瘤3例.主要症状为上消化道出血和不规则左上腹疼痛.5例存在孤立性胃底静脉曲张,其他3例同时伴有食管下段静脉曲张.所有患者均接受了联合脏器切除,手术切除范围包括胰体尾、脾脏,部分病例还涉及胃、左肾、左肾上腺和结肠脾曲切除.随访期间无再出血病例,死亡1例,转移复发2例.结论 肿瘤源性的区域性门静脉高压病例相对少见,积极地施行联合脏器切除并辅以断流是治疗此类病症的有效方法,预后相对满意.

Abstract：

Objective To investigate the etiology, clinical characteristics, diagnosis and treatment of regional portal hypertension caused by left upper abdominal malignant tumors. Methods From January 2006 to December 2009, a total of 8 patients presenting regional portal hypertension were treated at our hospital, whose clinical data were analyzed retrospectively. Results Pancreatic tumors (5/8) and retroperitoneal tumors (3/8) were the primary etiology, and the main symptoms included upper gastrointestinal bleeding and irregular left upper abdominal pain. Isolated gastric varices were the most distinct clinical features. All patients underwent multi-visceral resection including pancreatic body and tail and spleen. Tumor involved stomach, left kidney, left adrenal and splenic flexure of colon were also removed en bloc. During the follow-up period there was no recurrent upper gastrointestinal bleeding, one patient died and two patients developed metastasis or tumor local recurrence. Conclusion Regional portal hypertension caused by malignant tumor was relatively rare, aggressive resection of multi-viscera combined with devascularization was an effective therapy.

Surgical management of left upper abdominal malignant tumors complicating regional portal hypertension

Objective To investigate the etiology, clinical characteristics, diagnosis and treatment of regional portal hypertension caused by left upper abdominal malignant tumors. Methods From January 2006 to December 2009, a total of 8 patients presenting regional portal hypertension were treated at our hospital, whose clinical data were analyzed retrospectively. Results Pancreatic tumors (5/8) and retroperitoneal tumors (3/8) were the primary etiology, and the main symptoms included upper gastrointestinal bleeding and irregular left upper abdominal pain. Isolated gastric varices were the most distinct clinical features. All patients underwent multi-visceral resection including pancreatic body and tail and spleen. Tumor involved stomach, left kidney, left adrenal and splenic flexure of colon were also removed en bloc. During the follow-up period there was no recurrent upper gastrointestinal bleeding, one patient died and two patients developed metastasis or tumor local recurrence. Conclusion Regional portal hypertension caused by malignant tumor was relatively rare, aggressive resection of multi-viscera combined with devascularization was an effective therapy.