系统性治疗肝癌患者的门静脉高压管理:超越已知的前沿  

Management of portal hypertension in patients with hepatocellular carcinoma on systemic treatment:Beyond the known frontiers

作　　者：陈艳 杨永平 Chen Yan;Yang Yongping(Department of Outpatients,the Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China;Center of Tropical Liver Disease,Hainan Hospital of Chinese PLA General Hospital,Sanya 572013,Hainan,China)

机构地区：[1]解放军总医院第五医学中心门诊部,北京100039 [2]解放军总医院海南医院热带肝病中心,海南三亚572013

出　　处：《中国医学前沿杂志(电子版)》2025年第2期17-19,共3页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：国家“十三五”科技重大专项(2018ZX10725506);首都临床特色诊疗技术研究及转化应用(Z221100007422002)。

摘　　要：因缺乏可靠的诊断标准和治疗方法,在接受全身治疗的肝细胞癌(hepatocellular carcinoma,HCC)患者中,临床显著门静脉高压症(clinical significant portal hypertension,CSPH)的管理已成为一个关键问题。本述评旨在强调HCC和门静脉高压(portal hypertension,PH)之间的主要病理生理联系,同时讨论了当前和新兴PH治疗的临床策略。鉴于缺乏具体指南,建议在治疗期间进行内窥镜监测,静脉曲张出血的一级预防参照第七届国际门静脉高压共识会议(BavenoⅦ)推荐意见,二级预防应重视优先经颈静脉肝内门体分流术治疗在系统性治疗HCC患者的PH上消化道出血管理中的作用。对于晚期HCC患者,改进CSPH的诊断标准和监测指南是必要的。The management of clinical significant portal hypertension(CSPH)in patients undergoing systemic treatment for hepatocellular(HCC)has emerged as a critical concern due to the lack of reliable diagnostic criteria and therapeutic approaches.This review aims to highlight the primary pathophysiological links between HCC and portal hypertension(PH),while also addressing the current and emerging clinical strategies for the management of PH.Given the absence of specific guidelines,It's recommended that endoscopic surveillance be conducted during treatment,and primary prophylaxis of variceal bleeding should refer to the BavenoⅦrecommendations,and secondary prevention should emphasize the role of pre-emptive transjugular intrahepatic portosystemic shunt in the management of PH in patients with HCC on systemic treatment.Furthermore,in patients with advanced HCC,refinement of diagnostic criteria for CSPH and guidelines for its surveillance are warranted.

关 键 词：门静脉高压 肝细胞癌 系统治疗 经颈静脉肝内门体分流术 

分 类 号：R73[医药卫生—肿瘤]