中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (11): 916-917.

• 论著 • 上一篇    下一篇

特发性门静脉高压症诊断及治疗（附28例报告）

马秀现，薛明辉，孙玉岭，党晓卫，叶学祥，许培钦   

  1. 郑州大学第一附属医院普外科，河南郑州 450052
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-11-09 发布日期:2009-11-09

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-11-09 Published:2009-11-09

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摘要：

目的 探讨特发性门静脉高压症（idiopathic portal hypertension，IPH）的临床特点、诊断及治疗。方法 回顾分析郑州大学第一附属医院普外科1987-2008年诊治28例IPH的临床资料。结果 14例行脾切除加贲门周围血管离断术， 8例行脾腔静脉分流加贲门周围血管离断术，4例行脾肾静脉分流加胃冠状静脉缝扎术，1例行脾切除加肠腔 C形架桥术，1例行食管下段及贲门周围血管离断术。 27例随访 6个月至17 年,一般情况良好 ,脾功能亢进消失 ,无明显腹水 ,无再出血及肝性脑病发生。肝功能均正常，16例食管曲张静脉消失, 9例明显好转 , 3例无变化。 结论 治疗出血和预防复发是治疗IPH的关键问题，对于无肝功能衰竭者首选手术治疗，可以作门奇静脉断流术或门体分流术，对于不能耐受手术或术后再发静脉曲张破裂出血者，可以采用内镜下注射硬化剂或内镜下套扎治疗。

关键词: 特发性门静脉高压症, 非硬化性门静脉高压症

Abstract:

Diagnosis and treatment of idiopathic portal hypertension: a report of 28 cases MA Xiu-xian, XUE Ming-hui, SUN Yu-ling, et al. Department of General Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China Corresonding author: SUN Yu-ling, E-mail: ylsun@zzu.edu.cn Abstract Objective To investigate the clinical features, diagnosis and treatment of idiopathic portal hypertension. Methods The clinical data of 28 patients with idiopathic portal hypertension treated between 1987 and 2008 at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Results The operations included splenectomy and disconnection (14patients), the shunt from splenic vein to inferior vena cave and severed around cardiac blood vessels (8 patients), splenorenal shunt and gastric coronary vein suture (4 patients), splenectomy and the shunt from superior mesenteric vein to inferior vena cave by C-bridge ( 1 patient ), severed lower esophageal and around cardiac blood vessels ( 1 patient ) . Twenty-seven patients were followed up for six months to 17 years, who were in good condition. Hypersplenism, significant ascites, further bleeding and liver encephalopathy were disappeared. All liver function were normal. Esophageal varices was disappeared in 16 patients. Esophageal varices marked improvement in 9 patients. Esophageal varices did not change in 3 patients. Conclusion Cureing bleeding and prevention of recurrence of IPH are the key issue. The patients have no liver failure preferred surgical treatment which might be portal azygous disconnection or portosystemic shunt. The patients who can not tolerate surgery or were variceal bleeding after operation might be used endoscopic injection sclerotherapy or endoscopic ligation treatment.

Key words: idiopathic portal hypertension, non-cirrhotic portal hypertension