成人门静脉海绵样变性的诊断和治疗.pdf

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· 617 · 中华普通外科杂志 2004 年 12 月第 19 卷第 12 期 Chin J Gen Surg , December 2004 , Vol. 19 , No. 12
·论著·
成人门静脉海绵样变性的诊断和治疗
马秀现唐哲党晓卫许培钦
【摘要】目的探讨成人门静脉海绵样变性的诊断方法和治疗。方法对 31 例成人门静脉海
绵样变性患者的临床资料进行回顾性分析。结果 31 例患者术前均有出血史,术前均经超声检查提
示肝脏正常及门静脉海绵样变性,经脾穿刺门静脉造影或选择性肠系膜上动脉造影确诊。12 例行脾
动脉结扎、胃冠状静脉及分支结扎、肠腔 C 型架桥术,1 例行脾肾静脉架桥术。8 例已切脾断流后再
出血患者,结扎冠状静脉主干后,6 例行肠腔 C 型架桥术,1 例行肠系膜下静脉下腔静脉 C 型架桥
术, 1 例因静脉曲张和出血部位在空肠上段而行空肠节段切除术。6 例行脾腔架桥术,2 例行改良
脾肺固定术,脾肾架桥术和门静脉下腔静脉架桥术各 1 例,1 例行脾切除加贲门周围血管离断术。
术后随访 6 个月~4 年(随访率 100 %) ,食管胃底曲张静脉均减轻或消失,无再出血和肝性脑病发生。
结论多普勒超声检查和经皮脾穿刺门静脉造影是诊断本病的理想方法;门体分流术加门奇断流
术是治疗本病的最佳选择。
【关键词】高血压,门静脉; 门静脉造影术; 食管和胃静脉曲张
Diagnosis and treatment of portal hypertension caused by cavernous transformation of the portal vein in
adults MA Xiu xian , TANG Zhe , DANG Xiao wei , XU Pei qin Department of Surgery , the First Affiliated
Hospital , Henan Medical University , Zhengzhou 450052 , China
【Abstract】 Objective To investigate the diagnosis and treatment of portal hypertension caused by
cavernous transformation of the portal vein ( CTPV) in adults Methods A retrospective study was made on
clinical data of 31 adult upper GI bleeding patients with CTPV The diagnosis of CTPV in all cases were confirmed
by B ultrasonography or ultrasonic Doppler and by percutaneous splenoportograp