胰腺癌致门脉高压上消化道出血的临床分析

目的：总结胰腺癌致门脉高压性上消化道出血的诊治经验。方法：回顾性分析7例胰腺癌致门脉高压性上消化道出血的临床表现、诊断方法、治疗措施和疗效。诊断方法主要为超声、CT、MRI和内镜。结果：7例胰腺癌致门脉高压性上消化道出血中,胰颈癌2例,体尾癌5例。临床表现均有不规则性上腹疼痛、纳差、乏力、消瘦、脾脏肿大及上消化道出血,肝功能检查正常。增强CT和（或）MRI可见脾门周围及胃短静脉、胃网膜静脉扩张、迂曲。胃镜检查示孤立性胃底静脉曲张。上消化道出血以药物、内镜治疗为主,但总体预后差。结论：超声、CT、MRI和内镜检查联合特殊的临床特点,诊断胰腺癌致门脉高压性上消化道出血并不困难。治疗以内科保守治疗为主,不宜选择创伤较大的外科手术。

Upper gastrointestinal hemorrhage related to portal hypertension induced by pancreatic cancer：clinical analysis

Objective：To summarize the experience of diagnosis and management of upper gastrointestinal hemorrhage（UGIH） related to portal hypertension induced by pancreatic cancer. Methods： The clinical manifestations, diagnostic methods and therapeutic modalities were analyzed retrospectively in 7 patients with UGIH caused by portal hypertension due to pancreatic cancer. Diagnostic tools included ultrasonography（US）, computerized tomography （CT）, magnetic resonance imaging（MRI） and endoscopy. Results： 2 cases（2/7） were pancreatic neck carcinomas, and 5 cases （5/7） were pancreatic body and tail carcinomas. Clinical findings included abdominal pain, poor appetite, hypodynamia,emaciation,splenomegaly and UGIH . All had normal liver function test. Enhanced CT or MRI could demonstrate enlarged tortuous short gastric veins, gastroepiploic veins, and collateral vessels around splenic hilum. Isolated gastric varices were revealed mainly by gastroscopy. UGIH was treated mainly by medications and/or endoscopy, but with poor prognosis. Conclusion： It is not difficult to diagnose UGIH caused by portal hypertension due to pancreatic cancer on the basis of findings of US, CT or MRI and endoscopy, together with special clinical characteristics. The appropriate therapeutic option was conservative treatment, rather than surgery.