Zheng Kexin, Guo Xiaozhong, Feng Ji, Bai Zhaohui, Shao Xiaodong, Yi Fangfang, Zhang Yongguo, Zhang Rui, Liu Han, Romeiro Fernando Gomes, Qi Xingshun
Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), Shenyang 110840, China.
Postgraduate College, Jinzhou Medical University, Jinzhou 121000, China.
Gastroenterol Res Pract. 2020 Mar 27;2020:3825186. doi: 10.1155/2020/3825186. eCollection 2020.
Left-sided portal hypertension (LSPH) is a rare type of portal hypertension, which occurs due to obstruction, stenosis, or thrombosis within the splenic vein. Pancreatic diseases are the most common etiology of LSPH. This study is aimed at reporting our experiences and discussing the presentation, management, and prognosis of LSPH secondary to pancreatic diseases. . We retrospectively reviewed five patients who were diagnosed with LSPH secondary to pancreatic diseases at our department. We collected the demographic information, history, comorbidities, clinical presentations, laboratory tests, esophagogastroduodenoscopy (EGD), images, and outcome data.
Three elderly patients (>60 years old) were diagnosed with pancreatic cancer, of whom one underwent laparoscopic radical distal pancreatectomy and splenectomy, one received chemotherapy, and another one chose conservative management due to multiple systemic metastases. Two younger patients (<40 years old) were diagnosed with acute recurrent pancreatitis and chronic pancreatitis. Four of these five included patients presented with hematemesis and/or melena at our admission. All patients had gastric varices, and one of them also had esophageal varices. One elderly patient with metastatic pancreatic cancer underwent endoscopic variceal treatment as a rescue therapy but finally died of refractory gastrointestinal (GI) bleeding; another younger patient with chronic pancreatitis died of massive GI bleeding; and the remaining three patients survived at their last follow-up.
LSPH should be seriously taken into consideration in patients with pancreatic diseases who develop upper GI bleeding. Clinicians should individualize the treatment strategy of LSPH according to the patients' clinical conditions and nature of pancreatic diseases.
左侧门静脉高压（LSPH）是一种罕见的门静脉高压类型，由脾静脉梗阻、狭窄或血栓形成所致。胰腺疾病是LSPH最常见的病因。本研究旨在报告我们的经验，并探讨胰腺疾病继发LSPH的表现、治疗及预后。我们回顾性分析了在我科诊断为胰腺疾病继发LSPH的5例患者。收集了人口统计学信息、病史、合并症、临床表现、实验室检查、食管胃十二指肠镜检查（EGD）、影像学检查及结局数据。
3例老年患者（>60岁）诊断为胰腺癌，其中1例行腹腔镜根治性远端胰腺切除术和脾切除术，1例接受化疗，另1例因多发全身转移选择保守治疗。2例年轻患者（<40岁）诊断为急性复发性胰腺炎和慢性胰腺炎。这5例患者中有4例入院时出现呕血和/或黑便。所有患者均有胃静脉曲张，其中1例还伴有食管静脉曲张。1例老年转移性胰腺癌患者接受内镜下静脉曲张治疗作为挽救治疗，但最终死于难治性胃肠道（GI）出血；另1例年轻慢性胰腺炎患者死于大量GI出血；其余3例患者在最后一次随访时存活。
对于发生上消化道出血的胰腺疾病患者，应认真考虑LSPH。临床医生应根据患者的临床情况和胰腺疾病的性质制定LSPH的个体化治疗策略。
