胰源性门静脉高压症并发消化道出血的诊治分析OA

Objective To investigate the pathogenesis,diagnosis and treatment of pancreatic portal hypertension(PPH)complicated by gastrointestinal bleeding.Methods The clinical data of 21 patients with PPH complicated by gastrointestinal bleeding,admitted to Luoyang Hospital of Traditional Chinese Medicine from August 2011 to July 2025,were retrospectively analyzed.Results All 21 patients suffered from gastrointestinal bleeding caused by rupture of gastric fundal varices:of these,5 cases(23.81%)presented with hemorrhagic shock,while only 1 case was accompanied by lower esophageal varices.All patients successfully underwent surgical treatment centered on splenectomy,with individualized combined procedures such as distal pancreatectomy and internal drainage of pancreatic pseudocysts performed based on the primary pancreatic lesions.No intraoperative deaths occurred.The mean operation time was(150±40)min,the median intraoperative blood loss was 220(150,350)mL,and the mean postoperative hospitalization stay was(10.5±2.3)d.Postoperatively,3 cases developed mild complications,including 2 cases of pulmonary infections and 1 cases of mild pancreatic fistula,all of which resolved following symptomatic treatment.A total of 19 patients completed the follow-up,with a period ranging from 7 to 96 months,and a median follow-up time of 42.5(24.2,60.8)months.The recurrence rates of gastrointestinal bleeding including esophageal variceal rupture bleeding were all 0 at 1,3,and 5 years post-operation.Conclusion The pathogenesis of gastrointestinal bleeding in PPH is closely associated with impaired splenic venous drainage caused by primary pancreatic diseases.Diagnosis relies on a comprehensive assessment that combines the patient's history of primary pancreatic disease,clinical manifestations of gastrointestinal bleeding,and endoscopic and imaging examinations.Surgical treatment centered on splenectomy combined with targeted management of primary pancreatic lesions represents the first-line and effective strategy for this condition,which can effectively prevent recurrent bleeding and improve patient prognosis.