Luo Xuefeng, Nie Ling, Wang Zhu, Tsauo Jiaywei, Tang Chengwei, Li Xiao
Department of Gastroenterology, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, Sichuan, China.
Cardiovasc Intervent Radiol. 2014 Feb;37(1):108-13. doi: 10.1007/s00270-013-0625-z. Epub 2013 May 2.
Regional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.
From December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).
Technical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3-34) months, no recurrence of GI bleeding was observed.
Transjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.
区域性门静脉高压（RPH）是一种由脾静脉狭窄/闭塞引起的罕见临床综合征，可导致食管胃静脉曲张引起胃肠道（GI）出血。本研究评估了经颈静脉脾静脉血管内再通术治疗RPH继发GI出血患者的安全性和有效性。
回顾性分析2008年12月至2011年5月期间11例诊断为RPH并伴有GI出血且接受经颈静脉脾静脉血管内再通术的患者。对比增强计算机断层扫描显示6例脾静脉狭窄，5例脾静脉闭塞。RPH的病因包括慢性胰腺炎（n = 7）、急性胰腺炎伴胰腺假性囊肿（n = 2）、胰腺损伤（n = 1）和孤立性胰腺结核（n = 1）。
11例患者中有8例通过经颈静脉途径获得技术成功，其中6例脾静脉狭窄患者和2例脾静脉闭塞患者。2例患者仅接受了脾静脉血管成形术，4例患者接受了裸支架置入，2例患者接受了覆膜支架置入。术后脾静脉压力梯度（SPG）从21.5±7.3 mmHg降至2.9±1.4 mmHg（P < 0.01）。其余3例技术失败的患者接受了脾动脉栓塞及随后的脾切除术。在中位随访时间17.5（范围3 - 34）个月内，未观察到GI出血复发。
经颈静脉脾静脉血管内再通术是治疗RPH合并GI出血患者的一种安全有效的治疗选择，且与手术相关并发症风险增加无关。
