Di-san junyi daxue xuebao (Nov 2019)
Clinical characteristics of regional portal hypertension in 3 576 patients: a systematic analysis
Abstract
Objective To analyze the clinical characteristics of 3 576 patients with regional portal hypertension (RPH). Methods We searched the electronic databases for studies of RPH published in China from January, 1980 to June, 2019, and retrieved 150 articles involving a total of 3 576 patients with RPH. The gender, age, geographical distribution, etiology, clinical manifestations, examination methods, treatment and prognosis of the patients were analyzed. Results Among the 3 576 patients with RPH, 2 340 (65.44%) were males and 1 236 (34.56%) were females with a mean age of 50.23 years. The causes of RPH were mostly pancreatic diseases (92.03%), spleen diseases (1.68%) and retroperitoneal diseases (0.67%). Pancreatic RPH occurred often secondary to pancreatic tumors (34.40%), chronic pancreatitis (29.67%), pancreatic pseudocysts (16.28%) and acute pancreatitis (7.27%). The main clinical manifestations of RPH included splenomegaly (68.47%), upper gastrointestinal bleeding (54.92%), upper abdominal discomfort or pain (38.56%), and isolated gastric fundus varices (71.44%). The diagnosis of RPH relied heavily on CT findings (24.41%), and the diagnostic value of gastroscopy or color Doppler ultrasound alone was limited. The treatments of RPH included splenectomy (70.92%), endoscopic treatment (4.65%), splenic artery embolization or ligation (3.97%); these treatments resulted in a disease improvement rate of 83.20%, but still 2.20% of the patients died due to upper gastrointestinal hemorrhage. Conclusion The incidence of RPH is higher in male than in female patients, and pancreatic disease is the most common etiology. For diagnosis with a single modality, CT scan has the greatest diagnostic value for RPH. Splenectomy is the preferred treatment for RPH complicated by upper gastrointestinal bleeding, and the prognosis of the patients is associated with the etiology of RPH.
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