中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (05): 392-395.

• 专题笔谈 • 上一篇    下一篇

胰源性门静脉高压症的诊断及外科治疗

张太平, 展翰翔, 赵玉沛   

  1. 北京协和医院外科，北京100730
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-05-13 发布日期:2009-05-13

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-05-13 Published:2009-05-13

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摘要：

胰源性门静脉高压症是一种少见的门静脉高压症类型，脾静脉血栓形成或梗阻是其根本原因，其原发疾病包括胰腺炎症、肿瘤及其他胰腺疾病，可引起单纯门静脉脾胃区域的压力增高，临床上可根据病人临床表现、生化检查和影像学手段等进行综合诊断。外科治疗应采用个体化的治疗原则，胰腺原发疾病的治疗是基础及关键，对于胃肠道曲张静脉出血，脾切除术是有效的治疗手段，静脉曲张严重者可加做断流术，对于病变在胰体尾的胰源性门静脉高压，可在解除胰腺病变的同时切除脾脏，但不主张预防性脾切除术，无法耐受手术病人可考虑介入治疗。

关键词: 门静脉高压症, 胰腺

Abstract:

Diagnosis and surgical treatment of pancreatic sinistral portal hypertension ZHANG Tai-ping, ZHAN Han-xiang, ZHAO Yu-pei. Department of Surgery, Peking Union Medical College Hospital , Beijing 100730, China Corresponding author: ZHANG Tai-ping, E-mail: tpingzhang@yahoo.com Abstract Pancreatic sinistral portal hypertension (PSPH) is a rare type of portal hypertension. Splenic vein thrombosis or obstruction are its fundamental causes.Its primary diseases include pancreatitis,pancreatic tumors and other pancreas diseases.It can provoke a simple portal vein higher pressure on the spleen and stomach region. The diagnosis of PSPH is based on clinical, biochemical, and radiological evaluation. It should follow individualized principles for the management of PSPH:Treatment of pancreatic disease is the basis and key of PSPH. Splenectomy is the management of choice for cases complicated by variceal bleeding.Pericardial devascularization process is needed if the severe gastric varices are found. Splenectomy should be added to the pancreatic procedure in patients whose pancreatic diseases locate in the body or tail of pancrease, but preventive splenectomy is not recommended. Interventional therapy is suitable for those patients who can not tolerate the operation.

Key words: portal hypertension, pancreas