胰管内乳头状黏液腺瘤的外科结果

胰管内乳头状黏液腺瘤的外科结果 胰管内乳头状黏液腺瘤的外科结果 ?498?中华肝胆外科杂志2007年7月第13卷箜!塑In』11bj!!堡!』!!!!:!!:! 见,尽管EV在TIPS术后显着降低了门体循环压力,但仍有 部分病人存在再出血,建议对于EV应在最初的TIPS治疗 同时进行栓塞术,以控制出血.Shibata等l_1采用TIPS治 愈了保守治疗无效的5例造口周围静脉曲张出血和7例肛 门直肠静脉曲张出血,其中4例再发出血者,多普勒超声均 提示为TIPS阻塞所致,并在1年后行分流再通术.所以推 荐TIPS术后每3个月应常规行多普勒超声监测分流通路. 7.肝移植:由于决定门静脉高压症EV出血病死率的是 潜在肝病的严重度,所以全身情况允许的话,对终末期肝病 病人应行肝移植治疗.肝移植也可得到与TIPS相似的治 疗结果[6].因任何分流术都会给随后的肝移植带来困难,所 以如果要对将行肝移植的病人行临时性门静脉分流,建议行 远端的脾肾分流. 综上所述,门静脉高压症EV的诊治多种多样,增 强对照三维磁共振血管造影技术作为新兴的辅助检查手段 较有前景,治疗方面多种方法的联合应用是一趋势. 参考文献 [1]何振平.门脉高压症的异位静脉曲张.重庆医学,2002,31: 449—451. L2JLuchaPAJr.Spontanneoushemoperitoneum.JAmOsteo— pathASSOC,1996,96:364. L3]vogtPR,AnderssonLC,JenniR,eta1.DorsocraniaIliverre— sectionanddirecthepatoatrialanastomosisforhepaticvenous outflowobstruction:long-termoutcomeandfunctionalresuIt. AmJGastroenterol,1996,91:539. [4]PereaGJ,LagoOJ,MunozJF,eta1.Lowgastrointestinal bleedingduetoectopicvaricesasaresultofadhesions.Gastro— enterolHepatol,2000,23:287—289. L5JMishinI.Gallbladdervarices.RomJGastroentero1.2005. 14:165—168. [6]HandschinAE,WeberM,WeishauptD,eta1.Contrast-en— hancedthree-dimensionalmagneticresonanceangiographyfor visualizationofectopicvarices.DisColonRectum,2002,45: 154卜1544. L7]ShresthaR,DunkelbergJC,SchaeferJW.Idiopathiccolonic varices:anunusualcauseofmassivelowgastr0intestinalhem— orrhage.AmJGastroenterol,1995,90:486. r8]LahotiS,CatalanoMF,AlcocerE,eta1.Obliterationofe— sophagealvaricesusingEUS-guidedsclerotherapywithcolor Doppler.GastrointestEndosc,2000,51:331-333. [9]ZubefiBF,BalochQComparisonofendoscopicvafice~sclero— therapyaloneandincombinationwithoctreotideincontrollinga— cutevaficealhemorrhageandearlyrebleedinginpatientswithlow- riskcirrhosis.AmJGastroenterol,2000,95:768—771. r10]ThakebF,Salamaz,SalamaH,eta1.Thevalueofcombined useofN—Butyl一2一Cyan0acrylateandethanolamineoleateinthe mangementofbleedingesophagastricvarices.Endoscopy, 1995,27:358. [11]BhasinDK,MalhiNJ.Varicealbleedingandportalhyperten— sion:muchtolearn.muchtoexplore.Endoscopy,2002,34: 119—128. [12]NakamuraS,MitsunagaA,MurataY,eta1.Endscopicin— ductionofmucosalfibrosisbyargonplasmacoagulation(APC) foresophagealvarices:aprospectiverandomizedtrialofliga— tionplusAPCvsligationalone.Endoscopy,2001,33:210— 215. [13]SchaferTw,BinmoellerKF.Argonplasmacoagulationfor thetreatmentofcolonicvarices.Endoscopy,2002,34:661- 663. [14]MacedoTA,AndrewsJC,KamathPS.Ectopicvaricesinthegas— trointestinaltract:short-andlong-termoutcomesofpercutaneous therapy.CardiovascInterventRadiol,2005,28:178—184. [15]SonomuraT,SatoM,KshiK,eta1.Balloon—occludedretro— gradetransvenousobliterationforgastricvarices:afeasibility study.CardiovascInterventRadiol,1998,21:27—30. [16]乔海泉,刘冰,代文杰,等.门静脉高压症合并十二指肠异位 静脉曲张破裂出血一例.中华普通外科杂志,2002,17:555. [17]VangeliM,PatchD,TerreniN,eta1.Bleedingectopicvarices- treatmentwithtransjugularintrahepaticporto-systemicshunt (TIPS)andembolisation.JHepatol,2004,41:560-566. [18]McCashlandTM.Currentuseoftransjugularintrahepaticpor— tosystemic.CurrGastroenterol,2003,5:3卜38. [19]ShibataD,BrophyDP,GordonFD,eta1.Transjugularintra— hepaticportosystemicshuntfortreatmentofbleedingectopic variceswithportalhypertension.DisColonRectum,1999, 42:1581—1585. (收稿日期:2006—04—03) 胰管内乳头状黏液腺瘤的外科结果 FujinoYSuzuikiYYoshikawaTetal 该研究的目的是根据临床病理学特征评估胰腺胰管内 乳头状黏液腺瘤(IPMN)的外科治疗结果.作者运用临床病 理学对75例有IPMN的病人进行检查并评估适当的外科手 术治疗方法,包括全胰切除,胰腺部分切除(胰十二指肠切 除,远端胰腺切除和中段胰腺切除).IPMN分成两种类型: 主胰管型33例,分支胰管型24例.超声以及CT可以容易 检测出主要病灶的位置.术中超声是诊断病灶边缘累及范 围的最好方法,其精确度是主胰管型占74,分支胰管型占 96.16例行全胰切除术,其中12例切除肿瘤为恶性肿 ? 外刊摘译? 瘤,或者潜在恶性肿瘤,适合全胰切除.41例行部分胰腺切 除的病人中3例由于肿瘤进一步发展死亡.主胰管型乳头 状黏液腺瘤多预示肿瘤为恶性,并且适宜行全胰切除.长期 随访提示:16例全胰切除病人中5例有明显低血糖表现,其 中2例死亡.作者认为分支胰管型的IPMN可行部分胰腺 切除清除肿瘤,主胰管型IPMN可有选择性行全胰切除. [(黄辉摘自WorldJSurg,2006,30:1909—1914;邹一平校) 100091北京市,解放军总医院第二附属医院]