门静脉高压症外科治疗进展  

Research updates on surgical treatments for portal hypertension

作　　者：杨金伟[1] 马臻[2] 胡继科 宋天亮[2] 刘小红[2] 耿春雨 韩志坚 李玉民 陈昊[2] 

机构地区：[1]兰州大学第二临床医学院,730030 [2]兰州大学第二医院肿瘤外科 [3]甘肃省消化系统肿瘤重点实验室 [4]甘肃省消化系统普外科

出　　处：《中华肝胆外科杂志》2017年第9期640-645,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（81470791、31270532、81670594、81376597）;中央高校重点项目（1zujbky-2016-k16）;甘肃省自然科学基金（1606RJIA328）;兰州大学第二医院引进人才基金（ynyjrckyzx2015-1-01）

摘　　要：门静脉高压症常见于肝脏的慢性疾病，如血吸虫病、门静脉闭塞、肝硬化等。当肝静脉压力梯度（HVPG）〉5mmHg（1mmHg=0．133kPa）时即可诊断为门静脉高压症。门静脉高压症可引起食管下段胃底曲张静脉破裂出血、腹水、自发性细菌性腹膜炎、肝肾综合征、肝肺综合征、肝性脑病等严重并发症，是肝移植和肝硬化患者死亡的首要原因，严重威胁患者的生命。门静脉高压症的外科治疗经历了相关理论研究及动物试验期、临床前期试验及资料积累期、分流术与断流术两大术式迅速发展期以及介入、内镜、肝移植等外科治疗新技术高速发展期。随着对门静脉高压症认识的不断深入以及现代科学技术、医疗技术的高速发展，外科治疗门静脉高压症的术式得到极大改良，显著减少了术后并发症、提高了患者术后生活质量。但是，至今尚无一种术式能彻底治愈门静脉高压症。本文从介绍门静脉高压症外科治疗的病理生理学基础人手，回顾门静脉高压症外科治疗的历史及其进展以及曲张静脉破裂出血及再出血的治疗现状，以便为门静脉高压症的外科治疗提供参考。Portal hypertension is a common clinical syn- drome in chronic liver disease, such as schistosomiasis, portal vein occlusion cirrhosis and so on, which can be diagnosed when the hepatic venous pressure gradient is （HVPG） 〉 5 mmHg （1 mmHg =0. 133 kPa）. It could lead to gastroesophageal vari- cose veins rupture, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome, hepatic en-cephalopathy and some other serious complications, and is the primary death cause in cirrhosis and liver transplantation. The development of portal hypertension has experienced 4 phases in- cluding the research about portal hypertension related theories and animal trial phase, preelinieal tests and data accumulation phase , devaseularization and shunts rapid development phase, the development phase of new technologies such as interventional and endoscopic surgical treatment, liver transplantation since the middle of the 19th century. The surgical procedures have been modified, which greatly reduce the complication and improve the life quality after operation. But so far none of them can cure por- tal hypertension thoroughly. This paper not only introduces the pathophysiologic basis of the surgical treatment, but also reviews the history of its development to summarize the recent progress, which may facilitate its surgical treatment.

关 键 词：门静脉高压症 外科治疗 分流术 断流术 经颈静脉肝内门体分流术 肝移植 

分 类 号：R657.34[医药卫生—外科学]