胰源性门静脉高压症的诊治进展

摘要

Pancreatic portal hypertension (PPH),which accounts for about 5％ of extrahepatic portal hypertension cases,is mainly caused by pancreatic tumor,chronic pancreatitis and pancreatic ductal lithiasis.The pathogenesis and pathological characteristics of PPH are attributed to anatomical structure between splenic vein and pancreas.It is different from cirrhotic portal hypertension,PPH patients may present with less esophageal and gastric fundus varices,but more significant gastric body varices.The portal vein radiography is recognized as the golden standard for PPH diagnosis.There are two types of treatment modalities for PPH,symptomatic treatment and pathogenesis-based treatment.In clinically,we should take careful consideration into portal hypertension and primary disease,aim to resolve causes and manage complication concurrently.%胰源性门静脉高压症(PPH)约占肝外型门静脉高压症5％,其主要病因为胰腺肿瘤、慢性胰腺炎和胰管结石.PPH的发病机制及病理特点是由脾静脉与胰腺之间的解剖关系所决定的.与肝硬化门静脉高压不同,PPH患者食管、胃底静脉曲张比率明显降低,而胃体部静脉曲张的比率明显升高.门静脉造影是诊断PPH的金标准.PPH的治疗分为对症处理和对因处理两方面,应既针对门静脉高压症又针对原发病,尽可能做到同时解除基础病变并治疗并发症.