Monneuse Olivier, Pilleul Frank, Barth Xavier, Gruner Laurent, Allaouchiche Bernard, Valette Pierre-Jean, Tissot E
Digestive and Emergency Surgery Department, Hôpital Edouard Herriot, Pavillon G visceral, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France.
World J Surg. 2007 May;31(5):1065-71. doi: 10.1007/s00268-006-0589-0.
Portal venous gas (PVG) has been reported to be associated with lethal surgical diagnosis. Recent studies tend to confirm the clinical significance of gas in the portal vein; however, some patients are managed without surgical treatment. The aim of this study was to assess both the diagnoses and the treatment of patients with PVG in an emergency surgical setting.
We performed a retrospective chart review of 15 patients with PVG in the emergency setting detected by computed tomography (CT) between July 1999 and July 2004. Characteristics assessed included age, sex, clinical presentation, first CT diagnosis of both PVG and the underlying pathology, American Society of Anesthesiologists (ASA) score, surgical findings, final clinical diagnosis, duration of hospitalization, and evolution of the illness/mortality. All patients were examined one month after operation.
This series of 5 women and 10 men ranged in age from 38 to 90 years at the time they underwent emergency surgical treatment. The mean preoperative ASA score was 4.20. Computed tomography diagnosed the underlying pathology in all cases: bowel obstruction (4 cases), bowel necrosis (9 cases), and diffuse peritonitis (2 cases). The mean length of hospital stay was 12.4 days. The mortality rate was 46.6%; (7 patients).
A wide range of pathologies can generate PVG. Computed tomography can detect both the presence of gas and the underlying pathology. In emergency situations, all the diagnosed causal pathologies required a surgical procedure without delay. We report that the prognosis was related to the pathology itself and was not influenced by the presence of PVG.
门静脉气体（PVG）已被报道与致命性手术诊断相关。近期研究倾向于证实门静脉气体的临床意义；然而，一些患者未接受手术治疗。本研究的目的是评估急诊手术环境下PVG患者的诊断和治疗情况。
我们对1999年7月至2004年7月间通过计算机断层扫描（CT）在急诊情况下检测出的15例PVG患者进行了回顾性病历审查。评估的特征包括年龄、性别、临床表现、PVG及潜在病理的首次CT诊断、美国麻醉医师协会（ASA）评分、手术发现、最终临床诊断、住院时间以及疾病进展/死亡率。所有患者在术后1个月接受检查。
这组患者包括5名女性和10名男性，接受急诊手术治疗时年龄在38至90岁之间。术前ASA评分的平均值为4.20。CT在所有病例中均诊断出了潜在病理：肠梗阻（4例）、肠坏死（9例）和弥漫性腹膜炎（2例）。平均住院时间为12.4天。死亡率为46.6%（7例患者）。
多种病理情况可导致PVG。CT既能检测到气体的存在，也能检测到潜在病理。在紧急情况下，所有已诊断出的病因性病理均需立即进行手术。我们报告预后与病理本身相关，不受PVG存在的影响。
