门静脉高压症治疗的现状与展望

本文涉及的内容是作为肝硬变合并症的门静脉高压症,这是门静脉高压症最常见的原因,也是最难治疗的,其后果也最严重。综观现代医学发展史,恐怕没有哪种疾患有这么多种内科和外科治疗手段问世,据不完全统计也有多达百种。治疗方法的多样恰恰说明治疗效果不满意。肝移植的出现     

肝移植与门静脉高压症

本文就肝移植与肝炎后肝硬变门静脉高压症 (以下称门静脉高压症 )的有关问题结合文献作如下复习。一、门静脉高压症肝移植治疗的指征与禁忌证肝移植的指征是肝病患者存在危及生命和影响病人生活质量的并发症的Child PughC级的病人 ,这些并发症包括肝性脑病、食管静脉曲张出血、顽固性腹水和严重的营养不良等。肝性脑病的生存质量很差 ,手术或曲张静脉硬化剂注射治疗不能改善病人的情况甚至加重脑病的表现 ;腹水是晚期肝病伴门静脉高压症病人的表现 ,顽固性腹水、反复的自发性腹膜炎的病人寿命很少超过 1年 ,患者需要反复放腹水缓解症状。…     

肝移植时代门静脉高压症外科手术方式的选择

肝硬变门静脉高压症最致命的并发症是食管和胃底静脉曲张破裂出血问题,外科手术治疗均试图从不同途径解决该并发症。国内外诸多学者创立并改良了多种分流及断流手术,但疗效始终无法令人满意。Starzl于1963年成功开展了全球首例肝移植手术,给门静脉高压症的外科治疗带来了革     

肝胆管结石并发肝硬变门脉高压症再手术问题(附20例临床报告)

肝胆管结石病再次手术率高。复杂的肝胆管结石病有高位胆管狭窄和胆管炎等病变,伴有多次手术史,有的有阻塞性黄疸,如持续时间长则可发生门静脉高压症或肝硬变门静脉高压症。肝外胆管壁及其周围的静脉丛或怒张的门静脉侧支,再次手术时易损伤致     

门静脉高压症的外科治疗

目的　评价门静脉高压症手术治疗的方式及其效果。方法　对各种治疗门静脉高压症手术进行综合性评价。结果及结论　门体分流术控制出血的近期及远期效果满意;且可缓解胃粘膜病变。其主要问题是门静脉向肝血流减少,甚至形成离肝血流。术后严重影响肝脏功能及脑病的发生,还有分流口血栓形成引起再出血的可能。远端脾肾静脉分流术由于存在“胰腺虹吸”现象,门静脉血流逐渐减少,可失去选择性分流意义。断流术阻断了门奇静脉间的反常血流,可防治曲张静脉破裂出血,又能保持门静脉的向肝血流。但术后再出血率较高,且无助于门静脉高压性胃病。分流加断流的联合术式既能保持一定的门静脉压力及门静脉向肝血供,又能疏通门静脉系统的高血流状态,是一种较理想的治疗门静脉高压症的手术方法。肝移植为彻底治愈肝硬变门静脉高压症带来了希望。     

腹腔镜治疗门静脉高压症现状

门静脉高压症是肝炎后肝硬变最为常见的并发症,其导致的脾脏功能亢进和食管胃底静脉曲张破裂出血是终末期肝病患者的致命并发症。虽然肝移植可以从根本上改善门静脉高压症患者的肝脏功能和降低门静脉压力,但由于肝脏供体匮乏,     

第八届全国门静脉高压症学术会议暨腹部外科再手术专题研讨会征文通知

中华医学会外科学分会门静脉高压症学组、中华外科杂志编辑部及中华普通外科杂志编辑部将在 2 0 0 1年 5月于青岛召开第八届全国门静脉高压症外科学术研讨会及腹部外科再次手术专题研讨会。会议征文包括以下内容 :(1)门静脉高压症手术的术式选择和血流动力学的关系。 (2 )肝移植和门静脉高压症。 (3)门静脉高压症非手术治疗和手术治疗的经验。(4 )门静脉高压症的实验研究。 (5 )门静脉高压症外科治疗与肝功能评估。 (6 )腹部外科手术合并症与再手术治疗经验。(7)腹部外科疾病的分期手术治疗问题。　　请将未公开发表过的论文全文及 80 0字以…     

第八届全国门静脉高压症学术会议暨腹部外科再手术 专题研讨会征文通知

中华医学会外科学分会门静脉高压症学组、中华外科杂志编辑部及中华普通外科杂志编辑部将在 2 0 0 1年 5月于青岛召开第八届全国门静脉高压症外科学术研讨会及腹部外科再次手术专题研讨会 ,会议将邀请著名专家就相关问题做演讲。参加会议的代表将获得中华医学会医学继续教育学分。会议征文包括以下内容 :(1)门静脉高压症手术的术式选择和血流动力学的关系。 (2 )肝移植和门静脉高压症。 (3)门静脉高压症非手术治疗和手术治疗的经验。 (4)门静脉高压症的实验研究。(5 )门静脉高压症外科治疗与肝功能评估。 (6 )腹部外科手术合并症与再手术治…     

第八届全国门静脉高压症学术会议暨腹部外科再手术专题研讨会征文通知

中华医学会外科学分会门静脉高压症学组、中华外科杂志编辑部及中华普通外科杂志编辑部将在 2 0 0 1年 5月于青岛召开第八届全国门静脉高压症外科学术研讨会及腹部外科再次手术专题研讨会 ,会议将邀请著名专家就相关问题做演讲。参加会议的代表将获得中华医学会医学继续教育学分。会议征文包括以下内容 :(1)门静脉高压症手术的术式选择和血流动力学的关系。 (2 )肝移植和门静脉高压症。 (3)门静脉高压症非手术治疗和手术治疗的经验。 (4 )门静脉高压症的实验研究。(5 )门静脉高压症外科治疗与肝功能评估。 (6 )腹部外科手术合并症与再手术治…     

第八届全国门静脉高压症学术会议暨腹部外科再手术专题 研讨会征文通知

中华医学会外科学分会门静脉高压症学组、中华外科杂志编辑部及中华普通外科杂志编辑部将在 2 0 0 1年 5月于青岛召开第八届全国门静脉高压症外科学术研讨会及腹部外科再次手术专题研讨会 ,会议将邀请著名专家就相关问题做演讲。参加会议的代表将获得中华医学会继续教育学分。会议征文包括以下内容 :(1)门静脉高压症手术的术式选择和血流动力学的关系。 (2 )肝移植和门静脉高压症。 (3)门静脉高压症非手术治疗和手术治疗的经验。 (4 )门静脉高压症的实验研究。 (5 )门静脉高压症外科治疗与肝功能评估。 (6 )腹部外科手术合并症与再手术治疗…     

Radiofrequency ablation for hypersplenism in patients with liver cirrhosis: A pilot study

Radiofrequency ablation is a relatively new technique used for local ablation of unresectable tumors. We investigated the feasibility and eficacy of radiofrequency ablation for hypersplenism and its effect on liver function in patients with liver cirrhosis and portal hypertension. Nine consecutive patients with hypersplenism due to cirrhotic portal hypertension underwent radiofrequency ablation in enlarged spleens. The ablation was performed either intraoperatively or percutaneously. Patients are followed up for over 12 months. After treatment, between 20% and 43% of spleen volume was ablated, and spleen volume increased by 4%–10.2%. White blood cell count, platelet count, liver function, and hepatic artery blood flow showed significant improvement after 1-year follow-up. Splenic vein and portal vein blood flow were significantly reduced. Only minor complications including hydrothorax (three of nine patients) and mild abdominal pain (four of nine patients) were observed. No mortality or other morbidity occurred. Radiofrequency ablation is a safe, effective, and minimally invasive approach for the management of splenomegaly and hypersplenism in patients with liver cirrhosis and portal hypertension. Increased hepatic artery blood flow may be responsible for sustained improvement of liver condition. Radiofrequency ablation may be used as a bridging therapy for cirrhotic patients waiting for liver transplantation.     

门静脉高压症治疗方法合理选择与评价

门静脉高压症的治疗方法较多,主要是针对其最严重的并发症--食管胃底静脉曲张破裂出血。目前达成的共识是出血的当时以非手术治疗即药物、内镜和介入治疗为主,应严格掌握各种治疗方式的适应证。手术治疗主要为断流、分流和肝移植三种手术方式,虽然肝移植是惟一有效的治疗手段。鉴于我国的经济和地域差异,传统手术方式仍将占据主导地位,但手术方式选择不影响今后行肝移植为先决条件。经颈静脉肝内门体分流术（TIPS）是等待肝移植的桥梁。病人的肝脏功能储备是决定生存时间长短的最重要因素。     

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??Reasonable choice of therapies for portal hypertension and the evaluation of its curative effects LI Hong-wei, ZHOU Guang-wen. Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China Abstract Although there are several types of treatment approaches for portal hypertension, its main goal has been to control gastroesphageal variceal bleeding. It is generally accepted that the non-surgical approaches such as drugs, endoscopy and intervention should be adopted when acute bleeding occurred and the indications of various approaches should be strictly managed. The surgical approaches include devasculation, shunting and liver transplantation. While liver transplantation has been the only effective treatment method, traditional surgical approaches such as devasculation and shunting still lie the occupying position for a long-term in the future due to the difference in economy and regions. It is requisite that the choice of surgical approaches should not be able to affect liver transplantation in the future. TIPS is a bridge between controlling bleeding and liver transplantation. The reservation of liver function would decide the survival time in patients with cirrhotic portal hypertension.     

肝移植时代的门静脉高压治疗

胃食管静脉曲张出血是门静脉高压的常见并发症。药物和内窥镜治疗是静脉曲张的基础治疗。经颈静脉肝内门体静脉分流被推荐用于处理难治性或复发性胃食管静脉曲张出血。当患者存在危及生命的出血风险,而传统治疗风险较高、存在禁忌或效果不理想时,应选择肝移植治疗。传统治疗可以获得短期疗效,甚至可以较长时间稳定病情,但如果这些治疗导致门静...     

Cure of gastric antral vascular ectasia by liver transplantation despite persistent portal hypertension: A clue for pathogenesis

Gastric antral vascular ectasia (GAVE) is a rare cause of chronic bleeding in cirrhotic patients. It has been suggested that these gastric lesions might be related to portal hypertension, hepatic insufficiency, or both parameters. We report two cases of cirrhotic patients in whom GAVE was the source of recurrent bleeding. These patients also had complete portal vein thrombosis. Liver transplantation was performed and an end-to-end cavoportal anastomosis was performed, leaving patients with persistent portal hypertension after surgery. We observed complete disappearance of the antral lesions several weeks after transplantation, which shows that the GAVE is not related to portal hypertension but is rather a direct consequence of liver failure. Possible pathophysiologic mechanisms are discussed. (Liver Transpl 2002;8:717-720.)     

Evidence that temporary complete occlusion of splenic vessels prevents massive embolization and sudden death associated with intrasplenic hepatocellular transplantation

It has been reported elsewhere that liver cell suspensions injected at several locations retain some proper hepatic functions, significantly improve the survival rate of rats with different models of acute fulminant hepatic injury, correct some congenital enzyme deficiency diseases, and improve liver function in cirrhotic animals. Among several locations, the splenic parenchyma has been shown to be the most suitable place for hepatocellular transplantation. Unfortunately, infusion of cells into the splenic pulp is not without risk. In fact, portal hypertension and hepatic embolizations have been described after intrasplenic transplantation of hepatocytes or pancreatic islets or fragments. In addition, pulmonary hepatocyte embolizations have been observed in rats with spontaneous (unpublished observations) or surgically induced portosystemic shunts. In this work, we evaluate the efficacy of temporary occlusion of splenic vessels to prevent hepatic and pulmonary embolizations after liver cell transplantation into the spleen in portal hypertension cirrhotic rats with portosystemic shunts.     

Impact of prior portosystemic shunt procedures on outcome of liver transplantation

BACKGROUND: Cirrhotic patients may require portosystemic shunts as treatment for complications of portal hypertension. The aim of this study was to asses how these procedures may influence the orthotopic liver transplantation procedure and its outcome. METHODS: Forty-five patients with a previous portosystemic shunt were divided into 3 groups (group 1, 19 with a portocaval shunt; group 2, 4 with a mesocaval shunt and 5 with a distal splenorenal shunts; group 3, 17 with a transjugular intrahepatic portosystemic shunt). Forty-five patients without a shunt, matched for age, gender, pretransplant liver status, and year of transplantation, were selected as controls. Surgical time, transfusional requirement, intensive care unit and total hospital duration of stay, complications, retransplantation rate, and short- and long-term mortality were analyzed. RESULTS: Group 1 showed a significantly longer surgical time, higher red blood cell transfusional requirements, longer intensive care unit and hospital stay, and greater short and long-term mortality than the controls. No significant differences were observed between groups 2 and 3 and the controls. CONCLUSIONS: In cirrhotic patients, surgically created portosystemic shunts involving the hepatic hilum have a negative impact on liver transplantation. This operation should be avoided in potential liver transplant candidates; surgical shunts that do not compromise the hepatic hilum or transjugular intrahepatic portosystemic shunts are preferred.     

原位肝移植术后门静脉并发症的诊治

目的 探讨原位肝移植术后门静脉并发症的诊断和治疗.方法 回顾性分析173例原位肝移植患者的临床资料.结果 本组原位肝移植术后有6例门静脉并发症(3.5%),门静脉狭窄发生率为1.2%,门静脉血栓发生率为2.3%,且术前3例有门静脉血栓,3例有门静脉高压症手术史.2例患者成功放置血管内支架,3例患者行套扎术或硬化剂治疗后好转出院,6例中无1例死亡.结论 术前存在门静脉高压症手术治疗史和门静脉血栓是门静脉并发症的高危因素.彩色多普勒超声检查是监测门静脉并发症的有效方法 ,确诊门静脉并发症则要依据门静脉CT血管成像.晚期门静脉血栓溶栓治疗效果不佳,对单纯性门静脉狭窄行介入治疗是安全可行的.     

肝移植时代门静脉高压症治疗策略

门静脉高压症病人肝移植手术的适应证为：（1）伴有肝功能失代偿的门静脉高压症上消化道大出血或反复出血者;（2）反复发生的自发性肝性脑病;（3）顽固腹水,内科治疗不能控制者。对有上消化道出血史者尤其是肝功能较差者,应大力强调应用非选择性β受体阻滞剂及规范的内镜下套扎治疗。应强调规范的、精确断流手术在肝硬化门静脉高压症外科治疗中的地位。     

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??Management of portal hypertension in an era of liver transplantation LENG Xi-sheng. Department of Surgery, Peking University People's Hospital, Beijing 100044,China Abstract The indications of patients with cirrhotic portal hypertension for liver transplantation could be summarized as: (1)Massive upper GI bleeding in a portal hypertensive patient complicated by liver disfunctions. (2) Recurrent spontaneous hepatic encephalopathy. (3)Intractable hepatic ascites.It should be emphasized that nonselective β-receptor blockers and esophageal varix ligatian should always be attempted in patients suffering from upper GI bleeding especially in those with compromised liver functions. Refined and pin-point gastroesophageal devascularization emphasizing the integrity of coronal and paraesophageal veins is effective in the prevention of recurrent bleeding as well as deterioration of liver functions