外科理论与实践

外科理论与实践 ›› 2022, Vol. 27 ›› Issue (04): 359-362.doi: 10.16139/j.1007-9610.2022.04.017

• 病例报告 • 上一篇    下一篇

经导管脾动脉栓塞术治疗胰源性门静脉高压致消化道出血(附1例报告)

陈晓娟1, 张雯2a, 蔡瑜2b()   

  1. 1.温州市人民医院消化科 温州医科大学温州市第三临床学院,浙江 温州 325000
    2a.复旦大学附属中山医院 介入科,上海 200032
    2b.复旦大学附属中山医院 消化科,上海 200032
  • 收稿日期:2021-03-05 出版日期:2022-07-25 发布日期:2022-09-20
  • 通讯作者: 蔡瑜 E-mail:cai.yu@zs-hospital.sh.cn

Transcatheter splenic artery embolization for pancreatic sinistral portal hypertension with gastrointestinal blee-ding: a case report

CHEN Xiaojuan1, ZHANG Wen2a, CAI Yu2b()   

  1. 1. Department of Gastroenterology, Wenzhou People’s Hospital, Wenzhou Third Clinical Institute Affiliated To Wenzhou Medical University, Zhejiang Wenzhou 325000, China
    2a. Department of Interventional Therapy, Shanghai 200032, China
    2b. Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • Received:2021-03-05 Online:2022-07-25 Published:2022-09-20
  • Contact: CAI Yu E-mail:cai.yu@zs-hospital.sh.cn

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摘要：

胰源性门静脉高压临床罕见,为脾静脉阻塞导致脾肿大,胃和(或)食管静脉曲张,但病人肝功能正常。胃静脉曲张是胰源性门静脉高压引起的严重并发症,发生率很高,且及时诊断和治疗很困难。迄今为止,尚无最佳治疗策略的相关共识。经导管脾动脉栓塞术是替代脾切除的方法,治疗胰源性门静脉高压引起的胃静脉曲张破裂出血,安全性和有效性均良好。本文报道1例复旦大学附属中山医院消化科的病人,因自身免疫性胰腺炎导致胰源性门静脉高压,引起胃静脉曲张破裂出血。病人确诊后行经导管脾动脉栓塞术治疗,胃静脉曲张破裂出血逐渐停止,胃静脉曲张明显改善。定期随访显示,病人术后无上消化道出血复发,也无术后并发症发生。结果表明,经导管脾动脉栓塞术治疗自身免疫性胰腺炎病人胰源性门静脉高压相关胃静脉曲张破裂出血,是微创安全有效的措施。

关键词: 脾动脉栓塞, 自身免疫性胰腺炎, 胰源性门静脉高压, 消化道出血

Abstract:

Pancreatic sinistral portal hypertension (PSPH) is a rare entity resulting from splenic vein obstruction and is characterized by splenomegaly, gastric and/or esophageal varices with normal liver function. PSPH-related gastric varices is one of severe complications with high incidence and is difficult for prompt diagnosis and treatment. To date, there is no consensus on treatment strategy. Splenic artery embolization (SAE) has been considered as an alternative strategy to splenectomy with satisfactory safety and efficacy for treatment of gastric bleeding caused by PSPH. Here we reported one case with autoimmune pancreatitis-related PSPH with gastric bleeding in Department of Gastroenterology Zhongshan Hospital. Treatment with transcatheter SAE led to gradual stop of gastric bleeding and much improvement of gastric varices. Follow-up study indicated that recurrence of upper gastrointestinal bleeding was not present without postoperative complication. The results suggest that SAE is a minimally invasive, safe and effective treatment strategy for controlling PSPH-related gastric variceal bleeding in the patient with autoimmune pancreatitis.

Key words: Splenic artery embolization, Autoimmune pancreatitis, Pancreatic sinistral portal hypertension, Gastro-intestinal bleeding

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