当代门静脉高压症治疗方法合理选择  

Reasonable choice of therapy for the treatment of portal venous hypertension

作　　者：李宏为[1] 陈皓[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普外科,上海200025

出　　处：《中国实用外科杂志》2014年第1期24-27,共4页Chinese Journal of Practical Surgery

基　　金：卫生部行业科研专项项目(201002015)

摘　　要：制定合理个体化治疗方案是治疗门静脉高压症的趋势。治疗前应对病人肝功能储备进行充分、客观的评价。门静脉高压症病人监测门静脉压力有重要意义,肝静脉压力梯度与病人食管、胃底曲张静脉破裂出血的存活率和预后密切相关。肝功能失代偿者,肝移植是最佳的治疗手段;但是对于肝功能尚好的病人,仍应采用保守治疗和(或)施行传统手术。控制急性出血及预防再次出血的一线治疗方法。推荐应用血管药物联合内镜治疗,经颈内静脉肝内门体分流术不应考虑作为门静脉高压并发症的首要治疗方法。传统外科手术主要针对肝功能Child-Pugh A、B级者,可有效防止复发出血及降低肝性脑病发生率,并获得较高的长期存活率。It has been confirmed that the protocol of individualized treatment is instituted for patient with portal hypertension. Sufficient and objective evaluation of the reserve of hepatic function should be done before the treatment of portal venous hypertension. It is very important to monitor portal venous pressure in patients with portal venous hypertension. Hepatic venous pressure gradient is related significantly to survive and prediction of patient with portal hypertensive bleeding episodes. Liver transplantation is the best choice for patients with decompensation of hepatic function. However, for patients with compensation of hepatic function, expectant therapy or/and traditional operation should be used. For controlling acute bleeding, it is vascular drugs plus endoscopic therapy not transjugular intrahepaticportosystemic shunt which is recommended for the first-line choice. Surgical operations afford protection against variceal rehemorrhage with a low occurrence of encephalopathy and long-term survival for patients with Child A or B.

关 键 词：门静脉高压 内镜 断流术 分流术 肝移植 

分 类 号：R6[医药卫生—外科学]