老年肝前型门静脉高压症诊治分析

【摘要】  目的 探讨老年肝前型门静脉高压症(prehepatic portal hypertension，PPH)的临床特点和治疗策略。方法 回顾分析15例PPH患者的诊治过程，结合国内外文献，总结治疗经验。结果 彩色多普勒超声及门静脉间接造影检查确诊，5例有典型门静脉海绵样变(cavernous transformation of the portal vein，CTPV)表现，5例为门静脉血栓形成，1例卵巢癌、2例胃体癌转移压迫脾静脉，2例因胃窦癌肝门转移压迫门静脉主干。行门体断流术8例，肠腔分流术2例，内镜下曲张静脉硬化剂注射(endoscopic sclerotherapy，EVL)及结扎治疗(endoscopic sclerotherapy，EST) 5例，平均随访（23.4±6.1）个月，死亡8例。结论 老年PPH病因复杂，肿瘤压迫脾静脉或门静脉主干占较大比例。诊断主要依靠彩超及门静脉造影，治疗方案根据患者个体情况而定。

【关键词】  肝前型；高血压，门静脉；彩色多普勒超声；门静脉间接造影；治疗

Prehepatic portal hypertension in elderly patients： an evaluation of the diagnosis and treatment 

　　MA Mao，LU Shaoying， MA Zhenhua， et al.

　　Department of Geriatric Surgery，the First Affiliated Hospital of Medical College，Xi’an Jiaotong University， Xi’an Shanxi 71006
 
　　Abstract   Objective  To explore and discuss the clinical features and treatment strategy of prehepatic portal hypertension (PPH) in elderly patients. Methods  Fifteen patients with PPH were reviewed and analyzed retrospectively. Results  All the diagnoses were established with color doppler ultrasonography evaluation and angiography of portal vein. Five typical cavernous transformation of the portal vein (CTPV) were found. Portal trunk thrombosis was found in 5 patients. And one patient’s splenic vein was occluded and invaded by recurrent ovary carcinoma. The splenic vein or portal vein of 4 cases was invaded by gastric carcinoma. Oesophagogastric devascularization was performed in 8 patients. Mesocaval shunt was performed in 2 patients. Five patients were cured with combined endoscopic variceal ligation (EVL) and endoscopic sclerotherapy (EST). The average follow-up period was （23.4±6.1）months in which eight patients was died. Conclusion  The causes of PPH in elderly patients are complexed. Tumor metastasis is a main problem. Color doppler ultrasonography and portal vein angiography are of the diagnosis aids. The treatm

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