胰源性门静脉高压症合并上消化道出血的治疗策略

摘要

The pathogenesis of pancreatic sinistral portal hypertension (PSPH)is quite different from that of cirrhotic portal hypertension, and PSPH is the only curable type of portal hypertension.Gastric variceal bleeding is a less common manifestation of PSPH;however,it probably exacerbates the patient’s condition and leads to critical illness,and inappropriate management would result in death.Therefore,it is necessary to develop the optimal management of upper gastrointestinal bleeding in PSPH patients.Splenectomy is considered as a definitive procedure,together with surgical procedures to treat underlying pancreatic diseases.For patients in poor conditions or ineligible for surgery, splenic artery coil embolization is a preferable and effective method to stop bleeding before second-stage operation.The therapeutic decision should be made individually,and the further multi-center study to optimize the management of upper gastrointestinal bleeding from PSPH is warranted.%胰源性门静脉高压症（PSPH）的发病机制和肝硬化性门静脉高压症完全不同，是唯一可被治愈的门静脉高压症。PSPH合并胃曲张静脉出血是相对少见的临床表现，但起病凶险，病情复杂，不恰当的治疗决策会延误病情，造成患者死亡。因此探索最优化的PSPH合并上消化道出血救治策略很有必要。脾切除是治疗PSPH继发消化道出血的确定性术式，同时实施针对胰腺原发疾病的术式。对于不适合手术的晚期肿瘤或手术高风险患者，优先选择疗效确切的脾动脉钢圈栓塞止血后再评估是否二期手术。PSPH出血的治疗须个体化决策，有必要开展多中心研究以获得最优化的PSPH出血治疗策略。