门静脉海绵样变性17例临床分析
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摘要
目的:通过对收集的17例门静脉海绵样变病例的分析,探讨门静脉海绵样变(CTPV)的临床特点、诊断方法及治疗。方法:对浙一医院2000年1月—2008年4月经影像学诊断或手术确诊的17例门静脉海绵样变患者的病因、临床表现、实验室检查、影像学检查、治疗及预后进行回顾性分析。结果:17例患者病因不一且多不明确,7例考虑原发性可能大,4例患者存在血栓状态,1例存在乙肝肝硬化;17例多以首次或反复呕血黑便、脾脏肿大、脾功能亢进、腹胀腹痛为主要就诊症状;肝功能检查多正常,部分患者血常规示一定程度的单系或三系降低。多数患者同时行超声检查、CT、MRI等检查,各种检查的诊断率基本达100%,且各种检查之间符合率100%。11例患者进行手术治疗,主要术式为肠腔分流术、贲门周围血管离断术,脾亢患者均同时行脾切除术。对17例患者均成功进行了随访,除1例手术患者再次复发出血外,另10例手术患者术后情况均稳定。结论:门静脉海绵样变分为原发性和继发性两类,临床表现主要以继发性门脉高压为主,如消化道出血、脾肿大、脾亢等,超声检查多能初步确诊,外科手术是其主要治疗方法,主要术式有脾切除、断流、分流术等。
Objective: According to the total 17 cases cavernous transformation of portal vein(CTPV),discuss the clinical characteristics, diagnostic methods and treatment of cavernous transformation of portal vein. Methods: A retrospective research was done in 17 patients with CTPV. visiting to The first affiliated hospital of ZheJiang University from January,2000 to April,2008.Result:The etiology of 17 patients is different and indefinite. The chief complain were firstly or repeated haematemesis, hemafecia, hypersplenotrophy, hypersplenia, abdominal distension and abdominal pain. All patient can be detected by ultrasonograph or CT or MRI. 11 patients were treated by operation, like splenectomy, by-pass technique or disconnection. All patients were fellow up ,most patients'have good general state of health after operation except one rehaematemesis. Conclusion CTPV is a kind of disease with unknown etiology, the clinical manifestation of which is secondary portal hypertension. Most cases could be detected by ultrasonography, and surgical operation is the main and best choice to cure CTPV.
Objective: According to the total 17 cases cavernous transformation of portal vein(CTPV),discuss the clinical characteristics, diagnostic methods and treatment of cavernous transformation of portal vein. Methods: A retrospective research was done in 17 patients with CTPV. visiting to The first affiliated hospital of ZheJiang University from January,2000 to April,2008.Result:The etiology of 17 patients is different and indefinite. The chief complain were firstly or repeated haematemesis, hemafecia, hypersplenotrophy, hypersplenia, abdominal distension and abdominal pain. All patient can be detected by ultrasonograph or CT or MRI. 11 patients were treated by operation, like splenectomy, by-pass technique or disconnection. All patients were fellow up ,most patients'have good general state of health after operation except one rehaematemesis. Conclusion CTPV is a kind of disease with unknown etiology, the clinical manifestation of which is secondary portal hypertension. Most cases could be detected by ultrasonography, and surgical operation is the main and best choice to cure CTPV.
引文
1.朱建平,涂卫东,颜普明.门静脉海绵样变性的超声诊断中国超声医学杂志,1994,10(6):42-44.
2.董晓秋,张秀凤.门脉海绵状变性的病因病理及其声像图特点,2001,10(8):510-511.
3.Tublin ME,Dodd GD,Baron RL.Benign and malignant portal vein thrombosis:Differentiation by CT characteristics.Am J Roentgenol,1997,168:719-723.
4.印隆林,宋彬.多排螺旋CT血管成像技术对门静脉海绵样变性侧支血管的显示,中国普外基础与临床杂志,2004,11(6):547-550.
5.刘于宝,胡道予,夏黎明等.门静脉海绵样变性门脉胆支及胆系改变的MRI 研究,2005,11(2):90-93.
6.李民利,金征宇.多层螺旋CT血管成像技术临床应用进展.国外医学临床放射学分册,2003,26(4):255.
7.Fuehs TO,Kaehelriess M,Kalender WA,et al.System performance of multi spiral computed toncraphy.IEEE Eng Med Biol Mag,2000,19(5):63.
8.朱希松,吴渭贤,章跃武,等.三维动态增强磁共振门静脉造影对门静脉癌栓的诊断价值口.放射学实践,2004,19(1):34-36.
9.陈建业,陈义雄,梁卫明,等.门静脉海绵样变性在肝癌介入治疗中的临床意义.放射学实践,2005,20(3):254-256
10.冯志杰,姚希贤,杨川杰.肝硬化并发门静脉血栓形成.中国全科医学,2003,6(6):458-459.
11.Condat B,Valla D.Portal vein thrombosis.Presse Med,2003,32(31):1460-1465.
12.Patraval V,Rathi P,Sawant P,et al.Endoscopic sclerotherapy in children with extra hepatic portal venous obstruction.Trop Gastroenterol,2001,22(3):137-140.
13.Warren WD,Henderson JM,Williken MS,et al.Management of vareceal bleeding in patient s with noncirrhotic portal vein thrombosis.Ann Surg,1998,207(5):623-34。
14.Brountzos EN,Malagari K,Alexopoulou E,et al.Transjugular intrahepatic portosystemic shunt in cavernomatous portal vein occlusion.Hepatogastroenterology,2004,51(58):1168-1171.
15.段林,朱壁富.脾动脉栓塞术的临床应用.普外临床,1992,7(2)::349-351.
16.陈少华,江艺,吕立志,张坤,魏炜明,肝硬化合并门静脉海绵样变性的外科治疗.福建医药杂志,2007,3(29):18-19.
17.冯子毅,刘磊,夏培,小儿门静脉海绵样变性的分型及手术方式选择的探讨.2007,14(8),114-115)
18.Vianna JL,Khamashta MA,Ordi-Ros J,et al.Comparison of the primary and secondary antiphopholipid syndrome:A european multicenter study of 114patients.Am J Med,1994,96:3-9.
19.Lee HJ,Park JW,Chang JC.Mesenteric and portal venous obstruction associated with primary antiphospholipid antibody syndrome.J Gastroenterol Hepatol,1997,12:822-826.
20.Ogimoto A,Sekiya M,Funada J,Miyagawa M,Kubo Y,Akutsu H.Antiphospholipid syndrome with acute myocardial infarction and portal vein occlusion.—A case repoot.Jpn Cire J,2000,64:468-470.
21.Denninger MH,Chart Y,Casadevall N,et al.Cause of portal or hepatic venous thrombosis in adults:The role of multiple concurrent factors.Hepatology 31:587-591,2000.
22.Khamashta MA,Cuadrado M J,Mujic F,Taub NA,Hunt BJ,Hughes GRV.The management of thrombosis in the antiphospholipid-antibody syndrome.N Engl J Med,1995,332:993-997.
22.Greaves M.Antiphospholipid antibodies and thrombosis.Lancet,1999,353:1348-135322.
23.Adam U,Makowiec F,Riediger H,et al.Pancreatic head resection for chronic pancreatitis in patients with extrahepatic generalized portal hypertension.Surgery,2004,135:411-418.
24.Terada T,Hoso M,Nakanuma Y,Ohta T,Makino H.Extrahepatic portal venous obstruction of different pathogenesis in pancreatic diseases:reports of 4 autopsy cases with chronic pancreatitis and pancreatic carcinoma22.Gastroenterol,Jpn,1989,24(4):414-2022.
25.张月宁,钱家鸣,陆星华,鲁重美,胰腺疾病相关性门脉高压症59例临床分析,2006,26(11):721-72522.
1.朱建平,涂卫东,颜普明,门静脉海绵样变性的超声诊断,中国超声医学杂志,1994,10(6):42-44.
2.Naganuma H,Ishida H,Konno K,et al.Intrahepatic venous collateals.Abdom inal Imaging,1998,23:166-171.
3.Bilbao J I,Vivasl,Delgado C,Martinez-Cuesta A,et al.Portal hypertension:diagnostic imaging and imaging-guided therapy.Springer,2000,11:233-248.
4.Wang L Y,Lin ZY,Chang W Y,et al.Duplex pulsed Doppler sonography of portal vein thrombosis in hepatocellular carcinoma.Ultrasound Med,1991,10:265-269.
5.Ricci P,Cantisani V,Biancari F,et al.Contrast-enhanced color Doppler U S in malignant portal vein thrombosis.Acta Radiologica,2000,41:470-473.
6.Tessler FN,Gehring BJ,Gomes AS,et al.Diagnosis of portal vein thrombosis:value of color Doppler imaging.Am J Roentgenol,1991,157:293-296.
7.李民利,金征宇.多层螺旋CT血管成像技术临床应用进展.国外医学临床放射学分册,2003,26(4):255.
8.印隆林,宋彬.多排螺旋CT血管成像技术对门静脉海绵样变性侧支血管的显示.中国普外基础与临床杂志,2004,11(6):547-550.
9.Kreft B,Strunk H,Flack S,et al.Detection of thrombosis in the portal venous System:Comparison of contrast enhanced MR angiography with intraarterial digital subtraction angiography.Radiology,2000,216:86-92.
10.刘于宝,胡道予,夏黎明,等.门静脉海绵样变性门脉胆支及胆系改变的MRI研 究.中华肝胆外科杂志,2005,11(2):90-93.
11.朱希松,吴渭贤,章跃武,等.三维动态增强磁共振门静脉造影对门静脉癌栓的诊断价值口.放射学实践,2004,19(1):34-36.
12.陈建业,陈义雄,梁卫明,等.门静脉海绵样变性在肝癌介入治疗中的临床意义.放射学实践,2005,20(3):254-256.
[1]Marshall BJ,Warren JR.Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration.Lancet,1984,1:1311-1315
[2]张万岱,萧树东,胡伏莲等.幽门螺杆菌共识意见(2003·安徽桐城).中华消化杂志,2004,24(2):126-127
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2.董晓秋,张秀凤.门脉海绵状变性的病因病理及其声像图特点,2001,10(8):510-511.
3.Tublin ME,Dodd GD,Baron RL.Benign and malignant portal vein thrombosis:Differentiation by CT characteristics.Am J Roentgenol,1997,168:719-723.
4.印隆林,宋彬.多排螺旋CT血管成像技术对门静脉海绵样变性侧支血管的显示,中国普外基础与临床杂志,2004,11(6):547-550.
5.刘于宝,胡道予,夏黎明等.门静脉海绵样变性门脉胆支及胆系改变的MRI 研究,2005,11(2):90-93.
6.李民利,金征宇.多层螺旋CT血管成像技术临床应用进展.国外医学临床放射学分册,2003,26(4):255.
7.Fuehs TO,Kaehelriess M,Kalender WA,et al.System performance of multi spiral computed toncraphy.IEEE Eng Med Biol Mag,2000,19(5):63.
8.朱希松,吴渭贤,章跃武,等.三维动态增强磁共振门静脉造影对门静脉癌栓的诊断价值口.放射学实践,2004,19(1):34-36.
9.陈建业,陈义雄,梁卫明,等.门静脉海绵样变性在肝癌介入治疗中的临床意义.放射学实践,2005,20(3):254-256
10.冯志杰,姚希贤,杨川杰.肝硬化并发门静脉血栓形成.中国全科医学,2003,6(6):458-459.
11.Condat B,Valla D.Portal vein thrombosis.Presse Med,2003,32(31):1460-1465.
12.Patraval V,Rathi P,Sawant P,et al.Endoscopic sclerotherapy in children with extra hepatic portal venous obstruction.Trop Gastroenterol,2001,22(3):137-140.
13.Warren WD,Henderson JM,Williken MS,et al.Management of vareceal bleeding in patient s with noncirrhotic portal vein thrombosis.Ann Surg,1998,207(5):623-34。
14.Brountzos EN,Malagari K,Alexopoulou E,et al.Transjugular intrahepatic portosystemic shunt in cavernomatous portal vein occlusion.Hepatogastroenterology,2004,51(58):1168-1171.
15.段林,朱壁富.脾动脉栓塞术的临床应用.普外临床,1992,7(2)::349-351.
16.陈少华,江艺,吕立志,张坤,魏炜明,肝硬化合并门静脉海绵样变性的外科治疗.福建医药杂志,2007,3(29):18-19.
17.冯子毅,刘磊,夏培,小儿门静脉海绵样变性的分型及手术方式选择的探讨.2007,14(8),114-115)
18.Vianna JL,Khamashta MA,Ordi-Ros J,et al.Comparison of the primary and secondary antiphopholipid syndrome:A european multicenter study of 114patients.Am J Med,1994,96:3-9.
19.Lee HJ,Park JW,Chang JC.Mesenteric and portal venous obstruction associated with primary antiphospholipid antibody syndrome.J Gastroenterol Hepatol,1997,12:822-826.
20.Ogimoto A,Sekiya M,Funada J,Miyagawa M,Kubo Y,Akutsu H.Antiphospholipid syndrome with acute myocardial infarction and portal vein occlusion.—A case repoot.Jpn Cire J,2000,64:468-470.
21.Denninger MH,Chart Y,Casadevall N,et al.Cause of portal or hepatic venous thrombosis in adults:The role of multiple concurrent factors.Hepatology 31:587-591,2000.
22.Khamashta MA,Cuadrado M J,Mujic F,Taub NA,Hunt BJ,Hughes GRV.The management of thrombosis in the antiphospholipid-antibody syndrome.N Engl J Med,1995,332:993-997.
22.Greaves M.Antiphospholipid antibodies and thrombosis.Lancet,1999,353:1348-135322.
23.Adam U,Makowiec F,Riediger H,et al.Pancreatic head resection for chronic pancreatitis in patients with extrahepatic generalized portal hypertension.Surgery,2004,135:411-418.
24.Terada T,Hoso M,Nakanuma Y,Ohta T,Makino H.Extrahepatic portal venous obstruction of different pathogenesis in pancreatic diseases:reports of 4 autopsy cases with chronic pancreatitis and pancreatic carcinoma22.Gastroenterol,Jpn,1989,24(4):414-2022.
25.张月宁,钱家鸣,陆星华,鲁重美,胰腺疾病相关性门脉高压症59例临床分析,2006,26(11):721-72522.
1.朱建平,涂卫东,颜普明,门静脉海绵样变性的超声诊断,中国超声医学杂志,1994,10(6):42-44.
2.Naganuma H,Ishida H,Konno K,et al.Intrahepatic venous collateals.Abdom inal Imaging,1998,23:166-171.
3.Bilbao J I,Vivasl,Delgado C,Martinez-Cuesta A,et al.Portal hypertension:diagnostic imaging and imaging-guided therapy.Springer,2000,11:233-248.
4.Wang L Y,Lin ZY,Chang W Y,et al.Duplex pulsed Doppler sonography of portal vein thrombosis in hepatocellular carcinoma.Ultrasound Med,1991,10:265-269.
5.Ricci P,Cantisani V,Biancari F,et al.Contrast-enhanced color Doppler U S in malignant portal vein thrombosis.Acta Radiologica,2000,41:470-473.
6.Tessler FN,Gehring BJ,Gomes AS,et al.Diagnosis of portal vein thrombosis:value of color Doppler imaging.Am J Roentgenol,1991,157:293-296.
7.李民利,金征宇.多层螺旋CT血管成像技术临床应用进展.国外医学临床放射学分册,2003,26(4):255.
8.印隆林,宋彬.多排螺旋CT血管成像技术对门静脉海绵样变性侧支血管的显示.中国普外基础与临床杂志,2004,11(6):547-550.
9.Kreft B,Strunk H,Flack S,et al.Detection of thrombosis in the portal venous System:Comparison of contrast enhanced MR angiography with intraarterial digital subtraction angiography.Radiology,2000,216:86-92.
10.刘于宝,胡道予,夏黎明,等.门静脉海绵样变性门脉胆支及胆系改变的MRI研 究.中华肝胆外科杂志,2005,11(2):90-93.
11.朱希松,吴渭贤,章跃武,等.三维动态增强磁共振门静脉造影对门静脉癌栓的诊断价值口.放射学实践,2004,19(1):34-36.
12.陈建业,陈义雄,梁卫明,等.门静脉海绵样变性在肝癌介入治疗中的临床意义.放射学实践,2005,20(3):254-256.
[1]Marshall BJ,Warren JR.Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration.Lancet,1984,1:1311-1315
[2]张万岱,萧树东,胡伏莲等.幽门螺杆菌共识意见(2003·安徽桐城).中华消化杂志,2004,24(2):126-127
[3]Pennington K,Pedersen KJ,McManus CA.From Genome to Proteome:Back to the Future.Report on the 7th Siena meeting,September 3-7,2006.Proteomics,2007,7(3):332-336
[4]Akada JK,Shirai M,Takeuchi H,et al.Identification of the urease operon in Helicobacter pylori and its control by mRNA decay in response to pH.Mol.Microbiol,2000,36:1071-1084.
[5]Beier D,Spohn G,Rappuoli R,et al.Identification and characterization of an operon of Helicobacter pylori that is involved in motility and stress adaptation.J.Bacteriol,1997,179:4676-4683
[6]Beier D,Frank R,Molecular Characterization of Two-Component Systems of Helicobacter pylori.J.Bacteriol.2000,182,:2068-2076.
[7]Cole SP,Kharitonov VF,Guiney DG.Effect of nitric oxide on Helicobacter pylori morphology.J.Infect.Dis,1999,180:1713-1717.
[8] Donahue JP, Peek RM, van Doom LJ, et al. Analysis of iceA1 transcription in Helicobacter pylori. Helicobacter, 2000,5: 1-12.
[9] Fassbinder F, van Vliet AH, Gimmel V, et al. Identification of iron-regulated Genes of Helicobacter pylori by a modified Fur titration assay (FURTA-Hp). FEMS Microbiol. Lett, 2000,184:225-229.
[10] Forsyth MH, Cover TL. Communication in Helicobacter pylori: luxS is essential for the production of an extracellular signaling molecule. Infect.Immun, 2000, 68: 3193-3199.
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