内镜超声引导下门静脉压力梯度测定在动物实验中的应用初探

目的探究内镜超声引导下门静脉压力梯度（EUS-PPG）测定在正常小型猪模型中的应用及安全性。方法选取4只小型猪，雌雄各2只，月龄8~12个月，体重20~30 kg，在全麻下经线阵内镜超声引导，使用22 G穿刺针穿刺门静脉、肝静脉、下腔静脉，再使用中心静脉压模块测压，每条血管测3次取平均值。术中及术后监测生命体征，记录门静脉压力梯度（PPG）结果（PPG为门静脉压力与肝静脉或下腔静脉压力差值）以及操作相关并发症情况。结果4只猪均成功测压，门静脉压力（11.0±1.0）mmHg（1 mmHg=0.133 kPa），肝静脉或下腔静脉压力（7.3±1.1）mmHg，计算PPG为（3.8±0.9）mmHg。术中、术后无并发症发生。结论EUS-PPG测定技术成功率高，反映门静脉压力准确，且安全性好。     

不同剂量氯沙坦治疗大鼠门静脉高压性结肠病的效果

门静脉高压性结肠病(PHC)的发病率约为40.6%~([1]).霍丽娟等~([2])用缬沙坦对PHC大鼠进行治疗,发现其对PHC大鼠结肠黏膜具有明显保护作用.氯沙坦作为缬沙坦的同类药物,对PHC治疗具有较好预期效果.     

原发性肝癌患者肝静脉压力梯度与门静脉压力梯度相关性研究

目的 探讨原发性肝癌患者肝静脉压力梯度（hepatic vein pressure gradient, HVPG）与门静脉压力梯度（portal pressure gradient, PPG）相关性。方法 161例原发性肝癌患者在TIPS术中测量下腔静脉压力（inferior vena cava pressure,ICVP）、肝静脉自由压（free hepatic vein pressure, FHVP）、肝静脉楔压（wedged hepatic vein pressure, WHVP）和门静脉压力（portal vein pressure, PVP）,计算HVPG(HVPG=WHVP-FHVP)和PPG(PPG=PVP-IVCP)。结果 161例患者HVPG为（20.18±9.22）mmHg,PPG为（26.44±6.82）mmHg,2者无相关性（r=0.112）;PPG明显高于HVPG (P <0.05)。HVPG与PPG相差在5 mmHg以上者90例,占55.9%,HVPG与PPG相差在5 mmHg以内者71例,占44.1%。球囊阻断肝静脉造影有肝内静脉-静脉侧支分流（in...     

内镜超声引导下门静脉压力梯度测定辅助诊治肝小静脉闭塞症一例（含视频）

本文报道了一例采用超声内镜引导下门静脉压力梯度测定方式评估患者门静脉高压情况的肝小静脉闭塞症患者,与传统肝静脉压力梯度方式相比,超声内镜引导下门静脉压力梯度测定方法简单,测量准确,有良好的临床应用前景。     

肝静脉压力梯度在肝硬化门静脉高压症患者中的临床应用

测量肝静脉压力梯度（HVPG）是评估门静脉高压症最常用的方法。大量研究表明,HVPG可作为食管静脉曲张出血的预测因子,此外,HVPG还可作为一个预后指标,可方便临床医生以其做参考为静脉曲张出血的一级预防和二级预防来制定合适的治疗策略。现阶段的治疗目标是使HVPG下降到12 mm Hg以下或比基线值下降20%,达到此目标的患者其食管静脉曲张的首次出血和再出血的风险均大大降低。对于一级预防,非选择性的β受体阻滞剂,如心得安,临床已广泛应用;然而,再出血的发生率仍然很高,临床上常用包括非选择性β受体阻滞剂在内的药物联合治疗和内镜干预,如经颈静脉肝内门体静脉分流术（TIPS）、内镜下硬化剂注射和内镜下套扎。主要探讨目前HVPG的测量方法及其临床应用,并重点对在肝硬化中HVPG对食管静脉曲张出血和再出血及治疗反应的预测作用做详细阐述。     

肝静脉压力梯度对肝硬化临床终点事件的预测

肝硬化是肝脏疾病的终末阶段,失代偿期肝硬化以门静脉高压为显著特征,目前肝静脉压力梯度是评估门静脉高压的"金标准",具有重要的临床意义。对肝静脉压力梯度在代偿期及失代偿期临床终点事件中的预测作用以及在门静脉高压药物治疗效果评价中的应用进行阐述,以期为临床早预测、早预防、早干预门静脉高压提供依据。     

肝硬化患者门静脉压力与门静脉直径之间的关系

肝硬化合并门静脉高压症是临床上的常见病,多年来人们一直习惯用B超测得的门静脉直径值来推断门静脉高压症的严重程度,但很少有人对其准确性进行评价。我们用经皮经肝门静脉穿刺测压术测定了20例肝硬化患者的门静脉压力,并与B超测得的相同位点的门静脉直径做相关性分析。     

门静脉系统血流动力学与肝硬化门静脉高压的相关性

肝硬化门静脉高压导致的食管胃底静脉曲张出血是晚期肝硬化患者死亡的主要原因之一.目前仍缺乏简便易行的检测门静脉压力的方法和手段.本研究拟通过对89例肝病患者进行腹部彩色多普勒超声检查,了解门静脉系统血管直径和血流速度与肝硬化门静脉高压的相关性,为临床门静脉高压食管胃底静脉曲张出血的防治提供参考依据.     

B超导向下经皮经肝门静脉穿刺测压法及其对肝硬化患者门静脉压力的测定

门静脉压力测定是研究门静脉高压症的必要手段。我们在临床上采用B超引导下经皮经肝门静脉穿刺的方法测定肝硬化患者门静脉压力,其数据稳定,结果可靠,同时测定了正常人门静脉的压力。     

门静脉压力的无创性评估现状及进展

门静脉压力评估是研究门静脉高压的必要手段。肝静脉压力梯度被认为是诊断门静脉高压的金标准,但因其有创性而存在一定局限。总结了目前临床工作中常规使用的无创性门静脉压力评估方法,包括CT造影法、磁共振血管造影法、多普勒超声法、血清学指标和肝瞬时弹性成像等。此外,还介绍了基于三维血管模型提出的一种新型无创性门静脉压力测量技术,指出此方法不仅无创性地获得了门静脉的直接压力值和更加直观的血管三维模型,还可通过直接模拟的压力指标进行门静脉高压的诊断;然而,该技术目前尚处于临床验证阶段,其诊断准确性还有待于大样本量临床数据进一步证实。     

Intrahepatic pressure measurement: not an accurate reflection of portal vein pressure

Previous studies have established the reliability of percutaneous portal venous pressure measurement using a Chiba needle, a procedure requiring fluoroscopic guidance. Intrahepatic pressure has been advocated by some as a simple and safe index of portal venous pressure. The aim of this study was to examine the reliability of intrahepatic pressure measurement and its relationship to portal venous pressure. Fifty patients requiring liver biopsy were included: 29 with cirrhosis (n = 20 micronodular, n = 9 macronodular) and 21 with various hepatic disorders but no cirrhosis. The procedure was performed under fluoroscopic guidance, using a Chiba needle connected to a manometer by a saline-filled catheter. Immediately prior to biopsy, each patient underwent measurement of: (i) 3 to 5 separate intrahepatic pressures, the intraparenchymal site being inferred by the lack of blood or bile return; and (ii) portal and hepatic venous pressures, the intravascular position of the needle being ascertained by the reflux of blood and the vessel identified with injection of contrast. Intrahepatic pressure measurements showed great intraindividual variability (variation coefficient up to 115%). Mean intrahepatic pressure (13.19 +/- 8.32 mm Hg) was similar to portal venous pressure (14.43 +/- 6.10 mm Hg) in the noncirrhotics but significantly lower in the cirrhotics (intrahepatic pressure = 18.34 +/- 8.82 mm Hg, portal venous pressure = 22.52 +/- 9.47 mm Hg; p less than 0.01). The difference between these two parameters exceeded 3 mm Hg in 50% of patients (mean = 9 mm Hg, range = 4 to 19 mm Hg), both in cirrhotics and noncirrhotics.(ABSTRACT TRUNCATED AT 250 WORDS)     

Indications for portal pressure measurement in chronic liver disease

Abstract

Portal hypertension leads to development of serious complications such as esophageal varices, ascites, renal and cardiovascular dysfunction. The importance of the degree of portal hypertension has been substantiated within recent years. Measurement of the portal pressure is simple and safe and the hepatic venous pressure gradient (HVPG) independently predicts survival and development of complications such as ascites, HCC and bleeding from esophageal varices. Moreover, measurements of HVPG can be used to guide pharmacotherapy for primary and secondary prophylaxis for variceal bleeding. Assessment of HVPG should therefore be considered as a part of the general characterization of patients with portal hypertension in departments assessing and treating this condition.     

Indications for portal pressure measurement in chronic liver disease

Abstract Portal hypertension leads to development of serious complications such as esophageal varices, ascites, renal and cardiovascular dysfunction. The importance of the degree of portal hypertension has been substantiated within recent years. Measurement of the portal pressure is simple and safe and the hepatic venous pressure gradient (HVPG) independently predicts survival and development of complications such as ascites, HCC and bleeding from esophageal varices. Moreover, measurements of HVPG can be used to guide pharmacotherapy for primary and secondary prophylaxis for variceal bleeding. Assessment of HVPG should therefore be considered as a part of the general characterization of patients with portal hypertension in departments assessing and treating this condition.     

Endoscopic measurement of variceal pressure in cirrhosis: correlation with portal pressure and variceal hemorrhage

This study evaluated the clinical application of a pressure-sensitive gauge that allows the noninvasive measurement of the pressure of esophageal varices at endoscopy. The study was performed in 70 patients with cirrhosis and portal hypertension. Among them, 47 had bled from the varices and 23 had varices but had not bled. In addition to measurements of variceal pressure, the size of the varices was estimated semiquantitatively at endoscopy. This allowed an estimate of the tension on the wall of the varices as the product of the transmural pressure and the estimated radius of the varices. Most patients had a standard hemodynamic evaluation of portal hypertension, with measurements of wedged and free hepatic venous pressures, and of azygos blood flow. These were performed within 24 h of the variceal pressure measurements. Variceal pressure was significantly higher in bleeders than in nonbleeders (15.7 +/- 2.8 vs. 12.1 +/- 2.6 mmHg, p less than 0.001) in spite of a similar portal pressure in both groups (20.1 +/- 5.1 vs. 20.4 +/- 7.6 mmHg, NS). More than 60% of the bleeders, but only 22% of the nonbleeders had a variceal pressure greater than or equal to 15 mmHg (p less than 0.005). Among nonbleeders, variceal pressure was higher in patients with large varices (13.9 +/- 2 mmHg, n = 9) than in those with small varices (10.9 +/- 2.4 mmHg, n = 14) (p less than 0.01). Estimates of variceal wall tension further exaggerated the differences between bleeders and nonbleeders (66.1 +/- 22.6 vs. 32.0 +/- 19.8 mmHg.mm, p less than 0.001). More than 50% of bleeders, but just 9% of nonbleeders had an estimated variceal tension greater than 50 mmHg.mm (p less than 0.001). Our findings support the role of an increased variceal pressure in the pathogenesis of variceal hemorrhage, and suggest that this noninvasive technique can be valuable in assessing the risk of variceal hemorrhage in patients with portal hypertension.     

Percutaneous transhepatic measurement of the pressure gradient between the portal and hepatic veins

Abstract Background: Knowledge of the portal pressure may be of value in the assessment of patients with chronic liver disease but its measurement is problematic. Aims: To evaluate the ease and safety of percutaneous transhepatic measurement of the pressure gradient between the portal and hepatic veins and to determine directly the need for an internal zero. Methods: Sixty-one patients undergoing liver biopsy for suspected liver disease had pressures in branches of portal and hepatic veins measured using a flexible 22G (Chiba) needle. Results: The procedure was successful in all patients, took less than ten minutes in most, and was associated with minimal discomfort. Post-procedure morbidity was similar to that of liver biopsy. Portal pressure using an external zero (either puncture site or sternal angle) was inaccurate compared with pressures obtained using the generally accepted gold standard internal zero, hepatic venous pressure, and led to incorrect classification of the presence or absence of portal hypertension in at least 10% of patients. Variations in hepatic venous pressure were not predictable on clinical grounds. The only histopathological feature predictive of portal hypertension was cirrhosis, 20 of 25 patients with and four of 36 patients without cirrhosis having portal hypertension. Of routine biochemical and haematological tests, only plasma albumin and platelet count jointly (and negatively) predicted hepatic venous pressure gradient on multiple regression analysis (R²= 0.40). Conclusions: The use of an internal zero is essential for accurate measurement of portal pressure and this can be achieved safely using the percutaneous, transhepatic route in patients with well compensated liver disease.     

Evaluation of surgical procedure selection based on intraoperative free portal pressure measurement in patients with portal hypertension

BACKGROUND:Various surgical procedures can be used to treat liver cirrhosis and portal hypertension.How to select the most appropriate procedure for patients with portal hypertension has become a difficult problem.This study aimed to analyze the relationship between the value of intraoperative free portal pressure(FPP)and postoperative complications,and to explore the significance of intraoperative FPP measurement with respect to surgical procedure selection.METHODS:The clinical data of 187 patients with portal hypertension who received pericardial devascularization and proximal splenorenal shunt combined with devascularization(combined operation)at the Department of General Surgery in our hospital from January 2001 to September 2008 were retrospectively analyzed.Among the patients who received pericardial devascularization,those with a postoperative FPP ≥22 mmHg were included in a high-pressure group(n=68), and those with FPP22 mmHg were in a low-pressure group(n=49).Seventy patients who received the combined operation comprised a combined group.The intraoperative FPP measurement changes at different times,and the incidence of postoperative complications in the three groups of patients were compared.RESULTS:The postoperative FPP value in the high-pressure group was 27.5±2.3 mmHg,which was significantly higher than that of the low-pressure(20.9±1.8 mmHg)or combined groups(21.7±2.5 mmHg).The rebleeding rate in the high-pressure group was significantly higher than that in the low-pressure and combined groups.The incidence rates of postoperative hepatic encephalopathy and liver failure were not statistically different among the three groups.The mortality due to rebleeding in the low-pressure and combined groups(0.84%) was significantly lower than that of the high-pressure group.CONCLUSIONS:The study demonstrates that FPP is a critical measurement for surgical procedure selection in patients with portal hypertension.A FPP value≥22 mmHg after splenectomy and devascularization alone is an important indicator that an additional proximal splenorenal shunt needs to be performed.