内镜技术在门静脉高压中的应用展望  

Perspective in endoscopic technology in the management of patients with portal hypertension

作　　者：黄晓铨 陈世耀 HUANG Xiaoquan;CHEN Shiyao(Department of Gastroenterology and Hepatology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Evidence-Based Medicine Center,Fudan University,Shanghai 200032,China;Endoscopy Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院消化科,上海200032 [2]复旦大学循证医学中心,上海200032 [3]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中国临床医学》2024年第3期343-346,共4页Chinese Journal of Clinical Medicine

基　　金：上海市科委医学创新研究专项(22Y11907400)。

摘　　要：内镜下套扎、硬化和组织胶注射等联合药物治疗已取代外科断流或分流成为指南推荐的肝硬化门静脉高压食管胃静脉曲张出血治疗的首选方法。但是,部分静脉曲张出血由非肝硬化门静脉高压引起。合并糖尿病、门静脉血栓、肝肿瘤、肝动脉门静脉瘘等复杂的病理生理改变降低了内镜下套扎、硬化与组织胶注射等治疗的效果,同时可导致异位栓塞等并发症。传统内镜技术面临巨大挑战。内镜下精准注射、静脉曲张完全注射、避免异位栓塞并发症成为迫切需求。门静脉CT与超声内镜术前评估、超声内镜引导下弹簧圈联合组织胶精准注射、超声内镜术后即时评估等技术应用标志着静脉曲张内镜治疗进入精准医学时代。随着超声内镜技术的进展,超声内镜引导下门静脉压力测定、肝穿刺活检和分流手术等也有了初步尝试,并且将突破既往非肝硬化性门静脉高压的诊断与治疗瓶颈,联合门静脉CT影像虚拟等技术,替代经血管及经皮经肝体表穿刺介入技术,实现门静脉高压的内镜全流程诊断和治疗。Endoscopic ligation,sclerotherapy and injection of tissue glue combined with medicine treatment have replaced surgical shunt and devascularization as the first-line treatment recommended by guidelines for esophagogastric variceal bleeding in patients with cirrhosis and portal hypertension.However,some of the variceal bleeding induced by non-cirrhotic portal hypertension.Comorbidities such as diabetes,portal vein thrombosis,liver tumors,and hepatic artery-portal vein fistulas have reduced the efficacy of endoscopic treatment,and have increased the rate of complication such as ectopic embolism.Traditional endoscopic techniques are facing substantial challenges.The urgent needs for precise injection techniques,complete variceal obliteration,and the prevention of ectopic embolism have become apparent.The era of precision medicine in variceal endoscopic treatment has been ushered in by advancements such as preoperative assessments using computed tomography(CT)and ultrasound endoscopy,ultrasound-guided tissue glue injection with spring coil assistance,and immediate postoperative ultrasound endoscopic evaluation.This progress is anticipated to overcome the diagnostic and therapeutic limitations associated with non-cirrhotic portal hypertension.Integrating CT imaging virtual simulation and other technological innovations,to surpass conventional interventional techniques,is helpful of achieving a comprehensive endoscopic approach to the diagnosis and treatment of portal hypertension.

关 键 词：门静脉高压 肝硬化 内镜治疗 食管胃静脉曲张 超声内镜 

分 类 号：R575.21[医药卫生—消化系统]