Evans G R, Yellin A E, Weaver F A, Stain S C
Department of Surgery, University of Southern California, Los Angeles 90033.
Am Surg. 1990 Dec;56(12):758-63.
Between 1953 and 1988, 21 patients with splenic vein thrombosis (SVT), 12 of whom had sinistral portal hypertension (SPH) were treated at our institution. SVT was identified at autopsy in nine patients. Twelve additional patients presented with SPH: bleeding esophageal varices, SVT and normal hepatic function. SVT was caused by pancreatic neoplasm (5), chronic pancreatitis (5), and pancreatic pseudocyst (2). SVT was diagnosed by splanchnic angiography, splenoportography, computerized tomography, and ultrasonography. Gastric varices were diagnosed by endoscopy (10) and barium swallow (2). Splenectomy was performed as primary therapy in 10 patients. Three of these 10 had en block distal pancreatectomy. Two high-risk patients had splenic artery embolization, one as a prelude to splenectomy performed 48 hours later and the other as definitive therapy. One splenectomized patient continued to bleed. No further bleeding occurred in 10 splenectomized patients in follow-up from 1 week to 14 years. Sinistral portal hypertension is a clinical syndrome of splenic vein thrombosis caused by pancreatic pathology and manifests as bleeding gastric varices in patients with a patent portal vein and normal hepatic function. Splanchnic arteriography is necessary for accurate diagnosis. Splenectomy is the effective treatment of choice.
1953年至1988年间，我院共治疗21例脾静脉血栓形成（SVT）患者，其中12例患有左侧门静脉高压（SPH）。9例患者在尸检时发现有脾静脉血栓形成。另有12例患者表现为左侧门静脉高压：食管静脉曲张出血、脾静脉血栓形成且肝功能正常。脾静脉血栓形成的病因包括胰腺肿瘤（5例）、慢性胰腺炎（5例）和胰腺假性囊肿（2例）。脾静脉血栓形成通过内脏血管造影、脾门静脉造影、计算机断层扫描和超声检查来诊断。胃静脉曲张通过内镜检查（10例）和吞钡检查（2例）来诊断。10例患者接受了脾切除术作为主要治疗方法。这10例患者中有3例行整块远端胰腺切除术。2例高危患者接受了脾动脉栓塞术，1例在48小时后作为脾切除术的前奏，另1例作为确定性治疗。1例接受脾切除术的患者持续出血。10例接受脾切除术的患者在随访1周-14年期间未再发生出血。左侧门静脉高压是一种由胰腺病变引起的脾静脉血栓形成的临床综合征，表现为门静脉通畅且肝功能正常的患者出现胃静脉曲张出血。内脏动脉造影对于准确诊断是必要的。脾切除术是有效的治疗选择。
