Tsuchida Shinobu, Ku Yonson, Fukumoto Takumi, Tominaga Masahiro, Iwasaki Takeshi, Kuroda Yoshikazu
Department of Gastroenterological Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Surg Today. 2003;33(7):542-4. doi: 10.1007/s10595-002-2519-7.
Iatrogenic splenic vein occlusion is known to be a rare cause of left-sided portal hypertension. We herein describe the clinical course of a 43-year-old woman with isolated gastric varices, which proved to be attributable to a segmental splenic vein resection during an operation for a benign pancreatic tumor 11 years previously. Seven years after the initial operation, prominent gastric varices due to left-sided portal hypertension were first noted. During the follow-up period of 4 years, she had no episodes of gastrointestinal hemorrhaging. Although the size of the gastric varices did not change, she decided to have a splenectomy considering the potential risk of variceal hemorrhaging. It may be reasonable to perform a splenectomy concomitantly when the splenic vein is to be resected or ligated during pancreatic surgery to avoid the future development of left-sided portal hypertension. However, the role of prophylactic surgery in asymptomatic patients with iatrogenic splenic vein occlusion remains to be determined.
医源性脾静脉闭塞是左侧门静脉高压的罕见病因。我们在此描述一名43岁女性孤立性胃静脉曲张的临床病程，结果证明其病因是11年前因良性胰腺肿瘤手术时进行的节段性脾静脉切除术。初次手术后7年，首次发现因左侧门静脉高压导致的明显胃静脉曲张。在4年的随访期内，她没有发生过胃肠道出血。尽管胃静脉曲张的大小没有变化，但考虑到静脉曲张出血的潜在风险，她决定进行脾切除术。在胰腺手术中切除或结扎脾静脉时同时进行脾切除术以避免未来发生左侧门静脉高压可能是合理的。然而，预防性手术在无症状医源性脾静脉闭塞患者中的作用仍有待确定。
