中国普外基础与临床杂志

中国普外基础与临床杂志

胰腺假性囊肿致左侧门静脉高压伴脾脏功能亢进的处理策略探讨

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目的 探讨胰腺假性囊肿致左侧门静脉高压伴脾脏功能亢进(简称脾亢)的治疗策略。 方法 回顾性分析 2010 年 1 月至 2015 年 6 月期间四川大学华西医院胰腺外科收治的 49 例因胰腺假性囊肿致左侧门静脉高压伴脾亢患者的临床资料,分析其流行病学特征及临床特征,并对其中 36 例未合并上消化道出血仅有脾亢患者根据是否进行了脾脏切除手术分为未切脾组和切脾组,比较 2 组患者的术中及术后情况。 结果 49 例患者中男 38 例,女 11 例;年龄 22~67 岁。对于 13 例合并上消化道出血的胰腺假性囊肿致左侧门静脉高压伴脾亢患者中 1 例患者未行脾脏切除术,术后发生复发性消化道出血及脾亢未缓解,其余 12 例患者均行脾脏切除术且术后脾亢均缓解。对于 36 例未合并上消化道出血的胰腺假性囊肿致左侧门静脉高压伴脾亢患者中未行切脾者 23 例(未切脾组),行切脾者 13 例(切脾组)。切脾组在术中出血量、手术时间、术中输血比例及术中输红细胞悬液量方面均明显多于或长于或高于未切脾组(P<0.05)。2 组在术后住院时间及出院时实验室指标的比较中,除血小板外,其余指标比较差异均无统计学意义(P>0.05),而切脾组的术后消化道出血发生率明显低于未切脾组(P<0.05)且脾亢缓解率明显高于未切脾组(P<0.05)。 结论 对于胰腺假性囊肿致左侧门静脉高压合并脾亢患者,应提高警惕,及早干预。一般情况下仅处理原发病灶即可,若患者出现上消化道出血或术中发现胰尾炎性病灶与脾脏粘连紧密并压迫脾门可考虑术中同时行脾脏切除,可有效控制及预防消化道再出血及缓解脾亢。

Objective To explore treatment strategy of pancreatic pseudocyst induced left-sided portal hypertension (LSPH) complicated with hypersplenism. Methods The clinical data of 49 cases of pancreatic pseudocyst induced LSPH complicated with hypersplenism from January 2010 to June 2015 in this hospital were retrospectively analyzed. Among them, 36 patients who were not complicated with upper gastrointestinal bleeding were designed to splenectomy group and non-splenectomy group based on splenectomy or not. The epidemiological and clinical features, intraoperative and postoperative results of these two groups were compared. Results There were 38 males and 11 females with age ranging from 22 to 67 years old. As for 13 patients suffering LSPH complicated with hypersplenism caused by pancreatic pseudocyst with upper gastrointestinal bleeding, one patient didn’t accept splenectomy, then the upper gastrointestinal bleeding recurred and the hypersplenism was not alleviated after operation; Whereas, the hypersplenisms were relieved in the others patients after operation. In the 36 patients without upper gastrointestinal bleeding who were complicated with hypersplenism, 23 patients were performed splenectomy (splenectomy group) and 13 patients were not (non-splenectomy group). In the splenectomy group, the blood loss, operation time, and intraoperative blood transfusion were significantly more than those of the non-splenectomy group (P<0.05). The hospital stay and the discharged laboratory examinations had no significant differences between the splenectomy group and the non-splenectomy group (P>0.05) except for the platelet count. Furthermore, the incidence of the postoperative upper gastrointestinal bleeding was lower (P<0.05) and the relief rate of hypersplenism was higher (P<0.05) in the splenectomy group as compared with the non-splenectomy group. Conclusions For pancreatic pseudocyst induced LSPH with hypersplenism, we should be vigilant and early intervent. Usually, primary focus can be treated only. However, splenectomy can effectively relieve hypersplenism and prevent recurrent bleeding for patients with upper gastrointestinal bleeding or patients with close adhesion of pancreas tail and spleen inflammatory lesions and constricting splenic hilus.

关键词: 左侧门静脉高压; 胰腺假性囊肿; 脾脏功能亢进; 脾脏切除术

Key words: left-sided portal hypertension; pancreatic pseudocyst; hypersplenism; splenectomy

引用本文: 卢山, 陆慧敏, 张凌, 杨都江, 胡伟明, 张肇达. 胰腺假性囊肿致左侧门静脉高压伴脾脏功能亢进的处理策略探讨. 中国普外基础与临床杂志, 2018, 25(5): 553-558. doi: 10.7507/1007-9424.201712075 复制

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