Clinical Analysis Of 47 Cases Of Pancreatic Portal Hypertension

Objective:To investigate the etiology,clinical characteristics and treatment of pancreatic portal hypertension.Methods: From December 2011 to April 2018,47 patients with pancreatic portal hypertension were selected from more than 5000 patients with pancreatic diseases admitted to Shengjing Hospital affiliated to China Medical University.Their general data,clinical manifestations,involved veins,laboratory examination,imaging examination,treatment and prognosis were analyzed.Results: Of the 47 patients with pancreatic portal hypertension admitted in recent 6.5 years,41 were male and 6 were female.The most common underlying disease is acute pancreatitis(33 cases,70.2%).Splenic vein(44 cases,93.6%)was the most common vein involved in 47 patients.Gastric and esophageal varices were found in 30 cases(63.8%),including isolated gastric fundus varices in 28 cases(93.3%).After treatment,47 patients were improved and discharged from hospital.The treatment methods included conservative treatment in 36 cases(76.6%),percutaneous pancreatic pseudocyst drainage in 9 cases(19.1%),splenic artery embolization in 1 case(2.1%),splenectomy plus pericardial devascularization in 1 case(2.1%).As of July 2018,the follow-up rate was 93.6%.During the follow-up period,upper gastrointestinal hemorrhage occurred in some patients who received only conservative treatment and some who received pancreatic pseudocyst drainage.Conclusion: According to this study,PSPH patients have a low incidence rate,which is a rare complication of pancreatic diseases.The most common disease is acute pancreatitis.The clinical manifestations of PSPH are mainly the symptoms of pancreatic diseases themselves,and most patients do not have the symptoms of portal hypertension.There is no specific change in the patient's laboratory examination results,and the liver function is generally normal.The varices of PSPH patients are mainly isolated gastric fundus varices,rarely esophageal varices,which is different from cirrhosis and portal hypertension.For patients with pancreatic diseases,especially acute pancreatitis,gastrointestinal bleeding symptoms such as melena and hematemesis,we should be alert to the existence of PSPH,make clear the diagnosis and treatment in time,and reduce the risk of gastrointestinal hemorrhage.PSPH can be cured by surgery.Clinically,the patient's condition,the patient's wishes and the current level of medical technology should be comprehensively considered and individualized treatment should be carried out to optimize the curative effect,improve the prognosis and improve the quality of life of the patient.