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1、中华消化杂志2005年3月第25卷第3期ChinJDig,Mar.2005,Vol.25,No.3—131—·论著·区域性门静脉高压症的诊治刘全达周宁新张文智王茂强【摘要】目的总结区域性门静脉高压症的诊治经验。方法回顾性分析16例区域性门静脉高压症的临床表现、诊断方法、治疗措施和疗效。结果16例区域性门静脉高压症中,合并胰腺疾病12例,未发现明确胰腺疾病4例。临床表现主要为脾肿大16例(100%)、腹痛10例(63%)、消化道出血7例(44%)、腹部肿块3例(19%)。肝功能检查均正常。诊断方法主要为超声、CT和内镜。7例行彩色多普勒检查均提示脾静脉主干栓塞(7/7)。增强CT可明确脾门周围
2、及胃短静脉、胃网膜静脉扩张、迂曲(16/16)。胃镜检查示孤立性胃底静脉曲张(4/5)。脾脏切除对治疗消化道出血效果确切,发生门静脉栓塞1例。结论超声、CT和内镜检查联合特殊的临床特点,诊断区域性门静脉高压症并不困难。治疗上提倡个体化原则,但对有消化道出血者,应行脾脏切除术。【关键词】门静脉高压症;胰腺炎;脾静脉;胃静脉曲张;脾脏切除DiagnosisandmanagementofregionalportalhypertensionLIUQuan2da,ZHOUNing2xin,ZHANGWen2zhi,etal.InstituteofHepatobiliarySurgery,General
3、HospitalofChinesePLA,Beijing100853,China【Abstract】ObjectiveTosummarizetheexperienceofdiagnosisandmanagementofregionalportalhypertension.MethodsTheclinicalmanifestations,diagnosticmethodsandtherapeuticmodalitiesof16casesofregionalportalhypertensionwereanalyzedretrospectively.ResultsAmong16patientswi
4、thregionalportalhypertension,12casesresultedfrompancreaticdiseases,and4caseswerecomplicatedwithnon2pancreaticdiseases.Themainclinicalfindingsweresplenomegalyin16(100%),abdominalpainin10(63%),gastrointestinalbleedingin7(44%)andabdominalmassesin3(19%).Allhadnormalliverfunctiontest.Themaindiagnosticme
5、thodswereultrasonography(US),computerizedtomography(CT)andendoscopy.SplenicveinthrombosiscouldbedetectedbycolorDopplerultrasonography(7/7).EnhancedCTcoulddemonstrateenlargedandtortuousshortgastricveins,gastroepiploicveins,andcoll2ateralvesselsaroundsplenichilum(16/16).Isolatedgastricvarices(4/5)wer
6、erevealedmainlybygastro2scopy.Splenectomywaseffectiveforcontrollinggastrointestinalbleeding,anditscomplicationofportalveinthrombosisoccurredin1case.ConclusionsItisnotdifficulttodiagnoseregionalportalhyper2tensionbasedonfindingsofUSandCT,togetherwithspecialclinicalcharacteristics.Therapeuticoptionss
7、houldbeindividualizedaccordingtounderlyingdiseases,however,splenectomyshouldbeperformedinthepatientswithgastrointestinalbleeding.【Keywords】Portalhypertension;Pancreatitis;Splenicvein;Gastricvarices;Splenect
