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目的探讨胰源性左侧门静脉高压症(PSPH)的诊断及治疗方法。方法回顾性分析作者医院自2000年1月至2004年12月收治的15例PSPH及复习国内近10年报道的52例PSPH的临床资料。结果诊断方法主要为超声、CT、MRA(磁共振三维重建血管造影)、胃镜及腹腔动脉造影。8例(8/67)行单纯脾切除术,23例(23/67)行单纯脾切除+胰腺原发病治疗,13例(13/67)行脾切除+贲门周围血管离断术,21例(21/67)行脾切除+贲门周围血管离断+胰腺原发病治疗,2例(2/67)行脾动脉栓塞+曲张出血静脉硬化术。术后随访率89.6%(60/67),随访12～53个月,平均33.1个月。1例行单纯脾切除未断流者于术后13个月出现呕血,余59例病例术后均无再出血发生。结论胰源性左侧门静脉高压症的治疗应遵循“个体化原则”。对于无上消化道出血病史者,可行单纯脾切除术;对于有出血病史者应根据具体情况,可采取脾切除+贲门周围血管离断术、脾动脉栓塞术、内镜下曲张静脉硬化等方法,并且应同时重视对胰腺原发病的治疗。
Objective To investigate the diagnosis and treatment of pancreatic left portal hypertension (PSPH). Methods The clinical data of 15 cases of PSPH admitted to our hospital from January 2000 to December 2004 and 52 cases of PSPH reviewed in recent 10 years in our hospital were retrospectively analyzed. Results The main methods of diagnosis were ultrasound, CT, MRA (magnetic resonance angiography), gastroscopy and celiac angiography. Splenectomy was performed in 8 cases (8/67), simple splenectomy + primary pancreatitis in 23 cases (23/67), splenectomy in 13 cases (13/67) Cases (21/67) splenectomy + pericardial vascular disconnection + primary pancreatic disease treatment, 2 cases (2/67) of splenic arterial embolization + variceal bleeding atherosclerosis. Postoperative follow-up rate was 89.6% (60/67), followed up for 12 to 53 months with an average of 33.1 months. 1 cases of simple splenectomy did not cut off after 13 months of vomiting, more than 59 cases of postoperative no bleeding occurred. Conclusion The treatment of pancreatic left portal hypertension should follow the “principle of individuation”. For the history of upper gastrointestinal bleeding history, feasible simple splenectomy; for a history of bleeding should be based on the specific circumstances, can take splenectomy + pericardial vascular disconnection, splenic artery embolization, endoscopic varicose vein hardening method , And should pay attention to the treatment of primary pancreatic disease at the same time.