CAJ | 학술논문

目的探讨胰体尾肿瘤导致胰源性门静脉高压症的临床特点和诊治方法.方法回顾性分析北京协和医院2007年1月至2012年12月诊治的40例胰体尾肿瘤导致胰源性门静脉高压症患者的临床资料.结果本组40例胰源性门静脉高压症患者的首发症状分别为上腹部疼痛及不适12例,明显消瘦5例,腰背痛4例,脾肿大2例,呕血、黑便4例,低血糖昏迷1例.40例患者肝功能均正常,均有脾肿大和胃底静脉曲张,其中8例伴有食管下段静脉曲张,24例脾功能亢进,26例血清CA19-9升高.25例患者行手术治疗,15例行保守治疗.病理检查结果显示胰腺恶性肿瘤29例,良性肿瘤11例.35例患者获得随访,随访率为88％,随访时间12 ～ 72个月.接受手术治疗的患者在随访期间未出现上消化道出血,手术后脾功能亢进和胃底静脉曲张消失;非手术治疗患者在随访期间脾功能亢进程度无明显加重,有4例患者出现上消化道出血,经过药物治疗、内镜治疗和介入治疗后成功控制出血.结论胰体尾肿瘤导致的胰源性门静脉高压症手术治疗效果满意,门静脉高压症的临床表现可作为首发症状出现.
목적 탐토이체미종류도치이원성문정맥고압증적림상특점화진치방법.방법 회고성분석북경협화의원2007년1월지2012년12월진치적40례이체미종류도치이원성문정맥고압증환자적림상자료.결과 본조40례이원성문정맥고압증환자적수발증상분별위상복부동통급불괄12례,명현소수5례,요배통4례,비종대2례,구혈、흑편4례,저혈당혼미1례.40례환자간공능균정상,균유비종대화위저정맥곡장,기중8례반유식관하단정맥곡장,24례비공능항진,26례혈청CA19-9승고.25례환자행수술치료,15례행보수치료.병리검사결과현시이선악성종류29례,량성종류11례.35례환자획득수방,수방솔위88％,수방시간12 ～ 72개월.접수수술치료적환자재수방기간미출현상소화도출혈,수술후비공능항진화위저정맥곡장소실;비수술치료환자재수방기간비공능항진정도무명현가중,유4례환자출현상소화도출혈,경과약물치료、내경치료화개입치료후성공공제출혈.결론 이체미종류도치적이원성문정맥고압증수술치료효과만의,문정맥고압증적림상표현가작위수발증상출현.
Objective To evaluate the clinical characteristics,diagnosis and treatment method of pancreatic sinistral portal hypertension caused by tumors in the body and tail of the pancreas.Methods A retrospective review of 40 patients diagnosed with pancreatic sinistral portal hypertension at Peking Union Medical College Hospital from January 2007 to December 2012 was performed.Results The Initial symptoms were epigastric pain and discomfort (n =12),emaciation (n =5),low-back pain (n =4),splenomegaly (n =2),hematemesis and melena (n =4),hypoglycemic coma (n =1).All 40 patients had splenomegaly and varices in the gastric fundus with normal liver function.8 had combined esophageal varices.24 had hypersplenism and 26 had elevated serum CA19-9 level.25 patients received surgical intervention and 15 were treated conservatively.Pathology confirmed malignancy in 29 patients and benign lesions in 11.Thirty-five patients (35/40,88％) were followed up for 12 to 72 months.For patients undergoing surgery,hypersplenism and varices in the gastric fundus were all relieved.There was no upper gastrointestinal bleeding occurred during follow-up.For patients treated conservatively,hypersplenism remained stable and among them 4 patients had upper gastrointestinal bleeding,and successfully treated by medication,therapeutic endoscopy and interventional therapy.Conclusions Patients with pancreatic sinistral portal hypertension caused by tumor in the body and tail of the pancreas can be cured successfully by surgery.In those patients portal hypertension can present as initial clinical manifestation.