Diagnosis and treatment of pancreatic sinistral portal hypertension with splenomegaly / 中华肝胆外科杂志

ABSTRACT

Objective To study the diagnosis and treatment of pancreatic sinistral portal hypertension with splenomegaly.Method From January 2010 to December 2012,twenty-six cases of pancreatic sinistral portal hypertension with splenomegaly were retrospectively analyzed.Results The underlying pancreatic diseases were chronic pancreatitis (n=12,46 ％),pancreatic pseudocyst (n=5,19％),mass of pancreatic body and tail (n=6,23％),autoimmunie pancreatitis (n=2,8％) and pancreatic trauma (n=1,4 ％).All the 26 patients presented with splenomegaly,but there was no evidence of cirrhosis or abnormal hepatic function.Three cases presented with a history of upper gastrointestinal bleeding.Gastroscopy or upper gastrointestinal visualization revealed all 26 patients had varices in the gastric fundus and 6 patients had inferior segment oesophageal varices simultaneously.19 patients underwent operative treatment,2 patients underwent splenic artery embolization and 5 patients were treated conservatively.22 patients were followed up for 6 months to 30 months,the follow-up rate was 85 ％,and there were no upper gastrointestinal bleeding.Hypersplenism disappeared in all the 19 patients after operation.2 patients succumbed to pancreatic malignant tumor.Conclusions Splenomegaly is one characteristic clinical manifestation of pancreatic sinistral portal hypertension.It could be cured by operation.The choice of treatment depends on the patient's condition.The management of the primary pancreatic disease should also be emphasized.