胰腺肿瘤相关性区域性门静脉高压症的影像特征分析
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摘要
目的探讨胰腺肿瘤相关性区域性门静脉高压症(pancreatic tumor-related segmental portal hypertension, PTSPH)的临床和影像特点。方法分析PTSPH患者的临床和影像学资料,总结该病的特点。结果共搜集胰腺肿瘤患者312例,其中存在区域性门静脉高压20例。PTSPH组和非PTSPH组患者的年龄、性别差异无统计学意义(t=-0.69,P=0.50;χ~2=2.25,P=0.13),但肿瘤大小、发病部位和类型差异有明显统计学意义(t=2.82,P=0.01;χ~2=7.67,P=0.01;χ~2=4.55,P=0.03)。PTSPH患者静脉曲张发生率以脾门(100%)和胃底(95%)为主,食道下段仅为20%,脾脏增大发生率95%。其他少见征象包括脾静脉-左肾静脉的门体分流、脾静脉栓塞、脾静脉瘤样扩张等。结论多种胰腺肿瘤均可引起PTSPH,体尾部肿瘤、导管腺癌和体积较大肿瘤更易发生PTSPH。脾脏增大伴脾门和胃底静脉曲张是该病常见的影像征象,其他少见征象包括食管下段静脉曲张,左肾静脉曲张等门体分流现象。
Objective To analyze the clinical and imaging features of Pancreatic tumor-related segmental portal hypertension(PTSPH) in order to improve the diagnosis accuracy of the disease. Methods The clinical and imaging data of patients with PTSPH were retrospectively analyzed and the characteristics of the disease were summarized. Results A total of 312 patients with pancreatic tumors were collected, including 20 cases of regional portal hypertension. There was no significant difference in age and gender between PTSPH group and non-PTSPH group(t=-0.69, P=0.50; χ~2=2.25, P=0.13), but the difference in tumor size, location and type was statistically significant(t=2.82, P=0.01; χ~2=7.67, P=0.01; χ~2=4.55, P=0.03). The incidence of varicose veins in patients with PTSPH was mainly spleen portal and fundus vein(100% and 95%). The lower esophagus was only 20%, and the incidence of spleen enlargement was 95%. Other rare signs included splenic vein-left renal vein portal shunt, splenic vein embolization, and splenic vein tumor-like dilation. Conclusion PTSPH can be induced by variety of pancreatic tumors. It' s more likely to occur in tumors of the pancreatic tail, ductal adenocarcinoma and larger tumors. Spleen enlargement with spleen and fundal portal varices are common imaging sign of this disease, and other rare signs include lower esophageal varices, left renal varices, other portal shunts or so.
Objective To analyze the clinical and imaging features of Pancreatic tumor-related segmental portal hypertension(PTSPH) in order to improve the diagnosis accuracy of the disease. Methods The clinical and imaging data of patients with PTSPH were retrospectively analyzed and the characteristics of the disease were summarized. Results A total of 312 patients with pancreatic tumors were collected, including 20 cases of regional portal hypertension. There was no significant difference in age and gender between PTSPH group and non-PTSPH group(t=-0.69, P=0.50; χ~2=2.25, P=0.13), but the difference in tumor size, location and type was statistically significant(t=2.82, P=0.01; χ~2=7.67, P=0.01; χ~2=4.55, P=0.03). The incidence of varicose veins in patients with PTSPH was mainly spleen portal and fundus vein(100% and 95%). The lower esophagus was only 20%, and the incidence of spleen enlargement was 95%. Other rare signs included splenic vein-left renal vein portal shunt, splenic vein embolization, and splenic vein tumor-like dilation. Conclusion PTSPH can be induced by variety of pancreatic tumors. It' s more likely to occur in tumors of the pancreatic tail, ductal adenocarcinoma and larger tumors. Spleen enlargement with spleen and fundal portal varices are common imaging sign of this disease, and other rare signs include lower esophageal varices, left renal varices, other portal shunts or so.
引文
[1] 周尊强,周光文.重视胰源性门静脉高压症的诊治[J].中华肝脏外科手术学电子杂志,2017,6(4):251-253.
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[6] Helmink BA,Snyder RA,Idrees K,et al.Advances in the surgical management of resectable and borderline resectable pancreas cancer [J].Surgical Oncology Clinics of North America,2016,25(2):287-310.
[7] 雷正明,邓家琦,付文广,等.胰腺炎相关区域性门静脉高压伴上消化道大出血的治疗[J].中华肝胆外科杂志,2016,22(12):819-821.
[8] Saif MW,Kaley K,Lamb L.Pancreatic adenocarcinoma complicated by sinistral portal hypertension [J].Cureus,2016,8(7):689-689.
[9] 高茹,高峰,郝建宇.区域性门静脉高压症的临床分析[J].中华消化杂志,2011,31(1):21-23.
[10] 王伟林.联合门静脉/肠系膜上静脉切除的胰腺癌根治术[J].中华普通外科杂志,2017,32(9):725-727.
[11] Specific gastric blood vessels in sinistral portal hypertension [J].Internal Medicine,2018,57(7):1053-1054.
[2] 雷泽华,高峰畏,赵欣,等.胰源性门静脉高压症手术时机及手术方式的探讨[J].中华普通外科杂志,2018,33(7):556-558.
[3] 李兆申,郭洪雷.胰源性门脉高压症的诊治进展[J].肝胆外科杂志,2017,25(5):325-328.
[4] Sakorafas GH,Sarr MG,Farley DR,et al.The significance of sinistral portal hypertension complicating chronic pancreatitis [J].American Journal of Surgery,2000,179(2):129-133.
[5] Wang L,Liu GJ,Chen YX,et al.Sinistral portal hypertension:clinical features and surgical treatment of chronic splenic vein occlusion [J].Medical Principles and Practice,2011,21(1):20-23.
[6] Helmink BA,Snyder RA,Idrees K,et al.Advances in the surgical management of resectable and borderline resectable pancreas cancer [J].Surgical Oncology Clinics of North America,2016,25(2):287-310.
[7] 雷正明,邓家琦,付文广,等.胰腺炎相关区域性门静脉高压伴上消化道大出血的治疗[J].中华肝胆外科杂志,2016,22(12):819-821.
[8] Saif MW,Kaley K,Lamb L.Pancreatic adenocarcinoma complicated by sinistral portal hypertension [J].Cureus,2016,8(7):689-689.
[9] 高茹,高峰,郝建宇.区域性门静脉高压症的临床分析[J].中华消化杂志,2011,31(1):21-23.
[10] 王伟林.联合门静脉/肠系膜上静脉切除的胰腺癌根治术[J].中华普通外科杂志,2017,32(9):725-727.
[11] Specific gastric blood vessels in sinistral portal hypertension [J].Internal Medicine,2018,57(7):1053-1054.