Clinical Analysis Of Left-sided Portal Hypertension In20Cases

Objective:To evaluate diagnosis, treatment and prognosis of the left portal hypertension (LSPH).Methods:The clinical data of twenty patients with LSPH were reviwed retrospectively in SIR Run Run Shaw Hospital from Sep,2003-Aug,2010; Cox regression proportional hazards model was used in analysis of the risk factors influencing the prognosis. Before multivariate analysis, each parameter was evaluated with univariate analysis to define whether it was statistical significance (P<0.1) or not. Then the parameters with statistical significance entered for further multivariate analysis.Results:Total20patients accept in this research(M/13, F/7), patients’age:28-88(average51.2). the primary disease:9chronic pancreatitis,8pancreatic adenocarcinoma,1t pancreatitis,1left kidney tumor,] idiopathic retroperitoneal fibrosis.Therapeutic method:12patients received surgical treatment (6patients received laparoscopic distal splenopancreatectomy.2patients received internal drainage of pancreatic pseudocyst,1patient received calculus removed from pancreatic duct and splenectomy,2patients received esophagogastric devascularization with splenectomy,1patient received laparoscopic pancreaticpseudocysts with preliminary observation on sequential external and Internal drainage and pericardial devascularization;two patients of pancreatic cancer received chemotherapy;1patient with acute upper digestive tract bleeding received endoscopic hemostasis.5patients received symptomatic treatment.Treatment results:12patients received successful surgery had not occurred postoperative bleeding, pancreatic fistula, intra-abdominal infections and other complications. Postoperative hospital stay:4-33d (average11.4d), that in laparoscopy:4d.these12patients had alleviated in symptom and the bleeding was stop.1patient of pancreatic cancer with acute upper gastrointestinal bleeding dead of endoscopic hemostasis failure. Two patients received chemotherapy and another five patients were not improved.19patients were followed up.one patient was lost,12patients survived,7patients with cancer died.Two patients had gastrointestinal bleeding at follow-up,one was pancreas cancer.the other was acute exacerbation of chronic pancreatitis with splenic vein compression from pancreatic edema. The cumulative survival rates were65%at1year,59%at3years.Etiology and treatment were factors of prognosis.Conclusion:LSPH is a special type of portal hypertention.The prognosis mainly depends on causation of disease, surgery is an effective way to improve the prognosis. The surgical treatment of LSPH bases on splenectomy,as far as removal of the primary lesion possiblly.