慢性胰腺炎非阻塞性节段性门静脉高压症引流与切除术的前瞻性随机研究

Prospective randomized study of drainage and resection on non-occlusive segmental portal hypertension in chronic pancreatitis.

作者信息

Bloechle C, Busch C, Tesch C, Nicolas V, Binmoeller K F, Soehendra N, Izbicki J R

机构信息

Department of General Surgery, University Hospital Eppendorf, University of Hamburg, Germany.

出版信息

Br J Surg. 1997 Apr;84(4):477-82.

PMID:9112896

Abstract

BACKGROUND

In chronic pancreatitis, compression of the splenic vein and superior mesenteric vein (SMV) by an inflammatory mass may cause segmental portal hypertension. Drainage and resection are the principles of surgery for chronic pancreatitis. This study was devised to evaluate the effect of drainage and resection on venous splanchnic blood flow in patients with non-occlusive segmental portal hypertension.

METHODS

In 14 of 30 patients with chronic pancreatitis predominantly involving the pancreatic head, segmental portal hypertension due to compression of the splenic vein and SMV was detected by means of indirect splenomesentericoportography and Doppler ultrasonography. None of these 14 patients had symptomatic gastric fundic varices. They were allocated randomly to surgical drainage or resection. Median follow-up was 30 (range 12-48) months.

RESULTS

In the resection group, mean(s.d.) splenic vein blood flow increased from 316(46) ml/min before operation to 396(57) ml/min at follow-up (P < 0.01). In the drainage group, preoperative splenic vein blood flow (318(37) ml/min) was not increased after operation (322(37) ml/min). Mean(s.d.) SMV flow increased from 292(42) ml/min before operation to 436(64) ml/min at follow-up (P < 0.01) in the resection group. In the drainage group mean(s.d.) SMV blood flow was 296(32) ml/min before operation and 314(34) ml/min at follow-up. No patient developed fundic gastric varices during follow-up.

CONCLUSION

In non-occlusive segmental portal hypertension due to chronic pancreatitis, resection, but not drainage, restores normal venous splanchnic blood flow.

摘要

背景

在慢性胰腺炎中，炎性肿块对脾静脉和肠系膜上静脉（SMV）的压迫可导致节段性门静脉高压。引流和切除是慢性胰腺炎的手术原则。本研究旨在评估引流和切除对非闭塞性节段性门静脉高压患者内脏静脉血流的影响。

方法

在30例以胰头为主的慢性胰腺炎患者中，14例通过间接脾肠系膜门静脉造影和多普勒超声检测到因脾静脉和SMV受压导致的节段性门静脉高压。这14例患者均无有症状的胃底静脉曲张。他们被随机分配接受手术引流或切除。中位随访时间为30（12 - 48）个月。

结果

在切除组中，脾静脉平均（标准差）血流从术前的316（46）ml/分钟增加至随访时的396（57）ml/分钟（P < 0.01）。在引流组中，术后脾静脉血流（318（37）ml/分钟）未增加（322（37）ml/分钟）。切除组中，肠系膜上静脉平均（标准差）血流从术前的292（42）ml/分钟增加至随访时的436（64）ml/分钟（P < 0.01）。在引流组中，肠系膜上静脉平均（标准差）血流术前为296（32）ml/分钟，随访时为314（34）ml/分钟。随访期间无患者发生胃底静脉曲张。