肝硬化门静脉高压症患者超声内镜引导门静脉压力梯度测定：附52例报告

背景与目的：门静脉高压症的特征是门静脉压力梯度（PPG）增加，然而，传统的PPG测定方法困难、风险大，临床很难常规实施。前期的动物实验及人体试验均显示了超声内镜引导门静脉压力梯度（EUS-PPG）测定技术的可行性及准确性，且近期一项前瞻性研究在肝小静脉闭塞所致的急性或亚急性门静脉高压症患者中验证了EUS-PPG与肝静脉压力梯度（HVPG）存在一致性。然而，对于肝硬化门静脉高压症患者进行EUS-PPG测定的相关临床研究在国内尚未见相关报道。因此，本研究探讨肝硬化门静脉高压症EUS-PPG测定的准确性、可行性及安全性。方法：选取2022年3月—2022年8月中南大学湘雅三医院收治的52例肝硬化门静脉高压症进行EUSPPG测定，分析EUS-PPG测定结果及其与患者临床特征的关系。结果：52例患者中，47例既往或近期有食管胃静脉曲张出血史（14例既往经历过脾切除断流手术）。51例（98%）成功实施EUS-PPG,1例技术失败。门静脉穿刺途径分别为经胃壁（42例）或经十二指肠（9例），经胃壁穿刺肝静脉（10例）或肝后下腔静脉（41例），操作时长（15.5±3.4） min。51例患者的平均门静脉...

Endoscopic ultrasound-guided portal pressure gradient measurement in patients with cirrhotic portal hypertension: a report of 52 cases

Background and Aims Portal hypertension is characterized by an increased portal pressure gradient (PPG). However, the conventional method for PPG measurement is difficult and risky, so it is challenging to implement in a clinical setting routinely. Previous animal experiments and human tests have shown the feasibility and accuracy of the endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement techniques. A recent prospective study involving patients with subacute portal hypertension caused by occlusion of the small hepatic veins verified the consistency between EUS-PPG and hepatic venous pressure gradient (HVPG). However, there is no report assessing EUS-PPG measurement in patients with cirrhotic portal hypertension in China. Therefore, this study was performed to investigate the accuracy, feasibility, and safety of EUS-PPG measurement in cirrhotic portal hypertension.Methods A total of 52 patients with cirrhotic portal hypertension admitted to the Third Xiangya Hospital of Central South University from March 2022 to August 2022 were enrolled for EUS-PPG measurement. The EUS-PPG measurement results and their associations with the clinical features of patients were analyzed.Results In the 52 patients, 47 cases had a previous or recent history of esophageal and gastric variceal bleeding (14 cases had previous devascularization and splenectomy). EUS-PPG was successfully performed in 51 cases (98%), and technical failure occurred in one case. The approaches for portal vein puncture included that through the gastric wall (42 cases) or the duodenum (9 cases) and punch of the hepatic vein (10 cases) or retrohepatic inferior vena cava (41 cases) through the gastric wall. The operative time was (15.5±3.4) min. Of the 51 patients, the average portal vein pressure was (21.0±7.1) mmHg, the hepatic vein pressure was (5.7±5.5) mmHg and the PPG was (15.3±4.9) mmHg. Five patients underwent simultaneous portal vein and left gastric vein puncture for pressure measurement, and the results showed that the two pressure values were highly correlated (r=0.99, P=0.000 66). No adverse events were observed in all patients. The PPG value in patients who had previously undergone devascularization and splenectomy was significantly lower than that in those who had not undergone this procedure (12.8 mmHg vs. 16.3 mmHg, P<0.05), the PPG value in patients with a history of esophageal and gastric variceal bleeding was significantly higher than that in those with no history of this complication (16.8 mmHg vs. 11.8 mmHg, P<0.05), and there was no significant difference in PPG value among patients with different Child-Pugh classifications (P>0.05).Conclusion EUS-PPG is a new method for directly determining the pressure difference between the portal vein and hepatic vein, which is accurate, reliable, safe, and feasible. Transduodenal portal vein puncture or puncture of the dilated main branches of the portal vein can be performed instead when technical difficulties occur during conventional portal vein puncture.