论文部分内容阅读
目的探讨胰源性门脉高压症(pancreatic portal hypertension,PPH)的发病情况、病因、临床诊断及治疗。方法选择解放军总医院2009年5月-2015年5月收治的PPH患者34例,回顾性分析病因、临床特征、内镜特点、诊断手段及治疗方法。结果诊断主要依赖内镜、超声和CT,34例中基础胰腺病因有胰腺癌4例,胰腺实性假乳头状瘤1例,胰腺囊肿4例,慢性胰腺炎20例,急性胰腺炎5例。31例有呕血和(或)黑粪史,其中1例有失血性休克表现。所有患者均无肝硬化、腹水及肝功能异常等表现,均有脾大。胃镜和超声胃镜提示胃底、食管静脉曲张34例。外科手术治疗10例,其余经内科保守治疗或内镜下组织胶注射治疗,好转后保持随访。患者手术后预后良好,均没有复发上消化道出血。1例胰腺癌死于肿瘤晚期。结论 PPH具有孤立性胃底静脉曲张、脾大、无肝硬化、肝功能正常以及胰腺疾病病史等特征,结合内镜和多种影像学手段,能够较容易诊断出胰源性门静脉高压,须与肝源性门脉高压症区别,内镜联合内科保守治疗可控制急诊出血,采用综合治疗预后良好。
Objective To investigate the incidence, etiology, clinical diagnosis and treatment of pancreatic portal hypertension (PPH). Methods 34 cases of PPH patients admitted to PLA General Hospital from May 2009 to May 2015 were retrospectively analyzed. The etiology, clinical features, endoscopic features, diagnostic methods and treatment methods were retrospectively analyzed. Results The diagnosis mainly depends on endoscopy, ultrasonography and CT. Among the 34 cases, there were 4 pancreatic cancer, 1 pancreatic pseudopapillary tumor, 4 pancreatic cyst, 20 chronic pancreatitis and 5 acute pancreatitis. 31 cases had hematemesis and / or history of black manure, 1 of them had hemorrhagic shock. All patients without cirrhosis, ascites and liver dysfunction and other performance, have splenomegaly. Gastroscopy and ultrasound gastroscopy prompted gastric fundus, esophageal varices in 34 cases. Surgical treatment of 10 cases, the remaining conservative treatment by internal medicine or endoscopic injection of tissue glue, improved after the follow-up. Patients with good prognosis after surgery, no recurrence of upper gastrointestinal bleeding. One patient died of advanced cancer. Conclusion PPH has the characteristics of isolated varicose veins, splenomegaly, cirrhosis, normal liver function and history of pancreatic diseases. Combined with endoscopy and multiple imaging methods, PPH can diagnose pancreatic portal hypertension more easily, Hepatic portal hypertension difference, endoscopic combined with medical conservative treatment can control emergency bleeding, the comprehensive treatment of good prognosis.