左侧门脉高压症并上消化道出血的诊断与治疗（附14 例临床分析）

目的:探讨左侧门脉高压症合并上消化道出血的诊断和治疗方法。方法:回顾分析我院近10年来收治的14例左侧门脉高压症合并上消化道出血患者的诊治措施和随访结果。结果:14例患者均有呕血或(和)黑便史,无肝硬化、腹水及肝功能异常等表现。14例患者中胰体尾占位6例,胰腺假性囊肿4例,慢性胰腺炎4例。14例患者均采用手术治疗。9例患者获得随访,定期内镜复查,曲张静脉明显改善或消失,随访5月～8年均无再出血。结论:胰腺疾病病史、无肝硬化和肝功能正常、孤立性胃底静脉曲张和脾肿大及脾亢是诊断左侧门脉高压症的基本要点。该疾病可通过脾切除术或联合胃底周围血管离断术结合原发胰腺疾病的治疗来获得治愈。

The Diagnosis and Treatment of Left-Sided Portal Hypertension with UpperGastrointestinal Bleeding

Objective: To explore the diagnosis and treatment of left-sided portal hypertension with upper gastrointestinal bleeding.Methods: 14 cases of left-sided portal hypertension with upper gastrointestinal bleeding in our hospital were retrospectively analyzed.Results: All patients had history of upper gastrointestinal bleeding,but they had no cirrhosis,ascites and abnormal hepatic function.The underlying pancreatic diseases were pancreatic mass(n=6),pancreatic pseudocyst(n=4) and chronic pancreatitis(n=4).Nine patients were followed up for 5 months to 8 years,and there were no rebleeding.Conclusion: Pancreatic disease history,isolated gastric varices,splenomegalia and normal liver function could help to diagnose;left-sided portal hypertension could be cured by splenectomy or together with extensive devascularization around the cardia,but treatment to primary pancreas disease should be combined with.