Development of optimal management of upper gastrointestinal bleeding secondary to pancreatic sinistral portal hypertension
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摘要: 胰源性门静脉高压症(PSPH)的发病机制和肝硬化性门静脉高压症完全不同,是唯一可被治愈的门静脉高压症。PSPH合并胃曲张静脉出血是相对少见的临床表现,但起病凶险,病情复杂,不恰当的治疗决策会延误病情,造成患者死亡。因此探索最优化的PSPH合并上消化道出血救治策略很有必要。脾切除是治疗PSPH继发消化道出血的确定性术式,同时实施针对胰腺原发疾病的术式。对于不适合手术的晚期肿瘤或手术高风险患者,优先选择疗效确切的脾动脉钢圈栓塞止血后再评估是否二期手术。PSPH出血的治疗须个体化决策,有必要开展多中心研究以获得最优化的PSPH出血治疗策略。Abstract: The pathogenesis of pancreatic sinistral portal hypertension (PSPH) is quite different from that of cirrhotic portal hypertension, and PSPH is the only curable type of portal hypertension.Gastric variceal bleeding is a less common manifestation of PSPH;however, it probably exacerbates the patient's condition and leads to critical illness, and inappropriate management would result in death.Therefore, it is necessary to develop the optimal management of upper gastrointestinal bleeding in PSPH patients.Splenectomy is considered as a definitive procedure, together with surgical procedures to treat underlying pancreatic diseases.For patients in poor conditions or ineligible for surgery, splenic artery coil embolization is a preferable and effective method to stop bleeding before second- stage operation.The therapeutic decision should be made individually, and the further multi- center study to optimize the management of upper gastrointestinal bleeding from PSPH is warranted.
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[1]AGARWAL AK, RAJ KUMAR K, AGARWAL S, et al.Significance of splenic vein thrombosis in chronic pancreatitis[J].Am J Surg, 2008, 196 (2) :149-154. [2]BUTLER JR, ECKERT GJ, ZYROMSKI NJ, et al.Natural history of pancreatitis-induced splenic vein thrombosis:a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding[J].HPB (Oxford) , 2011, 13 (12) :839-845. [3]SONG Y, LIU QD, ZHOU NX, et al.The diagnosis and management of autoimmune pancreatitis:experience from China[J].World J Gastroenterol, 2008, 14 (4) :601-606. [4]WEBER SM, RIKKERS LF.Splenic vein thrombosis and gastrointestinal bleeding in chronic pancreatitis[J].World J Surg, 2003, 27 (11) :1271-1274. [5] LIU QD, ZHOU NX, ZHANG WZ, et al.Diagnosis and management of regional portal hypertension[J].Chin J Dig Dis, 2005, 6 (2) :87-92. [6] LIU QD, ZHOU NX, ZHANG WZ, et al.Diagnosis and management of regional portal hypertension[J].Chin J Dig, 2005, 23 (3) :131-133. (in Chinese) 刘全达, 周宁新, 张文智, 等.区域性门静脉高压症的诊治[J].中华消化杂志, 2005, 23 (3) :131-133. [7]STRASBERG SM, BHALLA S, SANCHEZ LA, et al.Pattern of venous collateral development after splenic vein occlusion in an extended Whipple procedure:comparison with collateral vein pattern in cases of sinistral portal hypertension[J].J Gastrointest Surg, 2011, 15 (11) :2070-2079. [8]OZAKI K, SANADA J, GABATA T, et al.Severe intestinal bleeding due to sinistral portal hypertension after pylorus-preserving pancreatoduodenectomy[J].Abdom Imaging, 2010, 35 (6) :643-645. [9]BOJAL SA, LEUNG KF, MESHIKHES AW.Traumatic pancreatic fistula with sinistral portal hypertension:Surgical management[J].World J Gastrointest Surg, 2010, 2 (7) :251-254. [10]LIU Q, SONG Y, XU X, et al.Management of bleeding gastric varices in patients with sinistral portal hypertension[J].Dig Dis Sci, 2014, 59 (7) :1625-1629. [11]SONG Y, SHEN H, LIU QD.The diagnosis and management of upper gastrointestinal bleeding due to pancreatogenic portal hypertension[J].Chin Gen Pract, 2006, 9 (10) :791-792. (in Chinese) 宋扬, 沈洪, 刘全达.胰源性门静脉高压症伴上消化道出血的诊治[J].中国全科医学, 2006, 9 (10) :791-792. [12]LOU WH, LI JA.Individualized treatment of pancreatic portal hypertension[J].Chin J Pract Surg, 2014, 34 (1) :28-29. (in Chinese) 楼文晖, 李剑昂.胰源性门静脉高压症的个体化治疗方法选择[J].中国实用外科杂志, 2014, 34 (1) :28-29. [13] ZHAO YP, LI XB, LI HW, et al.Guidelines for diagnosis and treatment of pancreatic sinistral portal hypertension (draft) [J].Chin J Gen Surg, 2013, 28 (5) :405-406. (in Chinese) 赵玉沛, 李晓斌, 李宏为, 等.胰源性门静脉高压症诊治规范 (草案) [J].中华普通外科杂志, 2013, 28 (5) :405-406. [14]CHENG LF, WANG ZQ, LI CZ, et al.Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate:10 years'experience of 635 cases[J].Chin Med J (Engl) , 2007, 120 (23) :2081-2085. [15]OU HY, HUANG TL, CHEN TY, et al.Emergency splenic arterial embolization for massive variceal bleeding in liver recipient with left-sided portal hypertension[J].Liver Transpl, 2005, 11 (9) :1136-1139. [16]LI L, ZHAO X.Treatment of rare gastric variceal bleeding in acute pancreatitis using embolization of the splenic artery combined with short gastric vein[J].Case Rep Gastroenterol, 2012, 6 (3) :741-746.
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