特发性门静脉高压症诊断及治疗

中国实用外科杂志2009年11月第29卷第11期论著

文章编号：1005-2208（2009）11-0916-02

特发性门静脉高压症诊断及治疗

（附28例报告）

马秀现，薛明辉，孙玉岭，党晓卫，叶学祥，许培钦

【摘要】目的探讨特发性门静脉高压症（idiopathic portal hypertension ，IPH ）的临床特点、诊断及治疗。方法回顾分析郑州大学第一附属医院普外科1987-2008年诊治28例IPH 的临床资料。结果14例行脾切除加贲门周

围血管离断术，8例行脾腔静脉分流加贲门周围血管离断术，4例行脾肾静脉分流加胃冠状静脉缝扎术，1例行脾

切除加肠腔C 形架桥术，1例行食管下段及贲门周围血管离断术。27例随访6个月至17年,一般情况良好,脾功

能亢进消失,无明显腹水,无再出血及肝性脑病发生。肝功能均正常，16例食管曲张静脉消失,9例明显好转,3

例无变化。结论治疗出血和预防复发是治疗IPH 的关键问题，对于无肝功能衰竭者首选手术治疗，可以作门

奇静脉断流术或门体分流术，对于不能耐受手术或术后再发静脉曲张破裂出血者，可以采用内镜下注射硬化剂

或内镜下套扎治疗。

【关键词】特发性门静脉高压症；非硬化性门静脉高压症

中图分类号:R6文献标志码:A

Diagnosis and treatment of idiopathic portal hypertension:a report of 28cases MA Xiu-xian,XUE Ming-hui,

SUN Yu-ling,et al.Department of General Surgery,the First Affiliated Hospital,Zhengzhou University,Zhengzhou

450052,China

Corresonding author:SUN Yu-ling,E-mail:ylsun@

Abstract Objective To investigate the clinical features,diagnosis and treatment of idiopathic portal hypertension.

Methods The clinical data of 28patients with idiopathic portal hypertension treated between 1987and 2008at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Results The operations included

splenectomy and disconnection (14patients),the shunt from splenic vein to inferior vena cave and severed around cardiac

blood vessels (8patients),splenorenal shunt

and gastric

coronary vein

suture

(4

patients),splenectomy and the shunt

from superior

mesenteric vein to inferior vena cave by C-bridge (1patient ),severed lower esophageal and around cardiac blood vessels (1patient ).Twenty-seven patients were followed up for six months to 17years,who were in good

condition.Hypersplenism,significant ascites,further bleeding and liver encephalopathy were disappeared.All liver

function were normal.

Esophageal

varices was

disappeared

in 16patients.Esophageal varices marked improvement in 9

patients.Esophageal varices did not change in 3patients.Conclusion Cureing bleeding and prevention of recurrence of IPH are the key issue.The patients have no liver failure preferred surgical treatment which might

be portal azygous disconnection or portosystemic shunt.The patients who can not tolerate surgery or were variceal bleeding after operation might be used endoscopic injection sclerotherapy or endoscopic ligation treatment.

Keywords idiopathic portal hypertension;non-cirrhotic portal hypertension 特发性门静脉高压症（idiopathic portal hypertension，IPH ）是非硬化性门静脉高压症（non-cirrhotic portal

hypertension，NCpH ）的一种，是一种肝内型门⁃静脉高压症，病因不明，临床上较为少见。本文对我科1987-2008年收治的28例IPH 的临床资料进行回顾性分析。

1临床资料

1.1一般资料本组28例，其中男17例,女11例。年龄

17～62岁。病人全身情况良好，无明显黄疸、无腹水及下

肢水肿。21例曾发生上消化道出血；除1例曾行脾切除外，其他病例脾脏均位于左侧肋缘下5～17cm；乙型肝炎抗原

作者单位：郑州大学第一附属医院普外科，河南郑州450052通讯作者：孙玉岭，E-mail：ylsun@ ··

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