肝硬化门静脉高压伴自发性门体分流的诊治现状与展望

陈雅鑫; 郭雯; 刘凯歌; 李茜; 张明鑫

doi:10.12449/JCH250127

肝硬化门静脉高压伴自发性门体分流的诊治现状与展望

DOI: 10.12449/JCH250127

陈雅鑫^{1, 2},
郭雯^{1, 2},
刘凯歌¹,
李茜¹,
张明鑫^1, , ,

1.
西安医学院第一附属医院消化内科，西安 710077
2.
西安医学院研工部，西安 710021

基金项目:

西安市科技计划项目 (23YXYJ0180);

西安医学院创新团队 (2021TD15);

佑安肝病感染病专科医疗联盟科研专项基金 (LM202028)

利益冲突声明：本文不存在任何利益冲突

作者贡献声明：陈雅鑫负责设计论文框架、起草论文；郭雯负责文献收集、数据提取；李茜、刘凯歌负责论文修改；张明鑫负责指导撰写文章及最后定稿。

详细信息

通信作者:
张明鑫， zmx3115@xiyi.edu.cn （ORCID： 0000-0002-3945-3387）

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出版历程
- 收稿日期: 2024-05-17
- 录用日期: 2024-06-11
- 出版日期: 2025-01-25

Diagnosis and treatment of cirrhotic portal hypertension with spontaneous portosystemic shunt: Current status and prospects

Yaxin CHEN^{1, 2},
Wen GUO^{1, 2},
Kaige LIU¹,
Qian LI¹,
Mingxin ZHANG^{1
, ,
,}

1.
Department of Gastroenterology，The First Affiliated Hospital of Xi’an Medical College，Xi’an 710077，China
2.
Graduate School of Xi’an Medical University，Xi’an 710021，China

Research funding:

Xi’an Science and Technology Plan Project (23YXYJ0180);

The Innovation Team of Xi’an Medical University (2021TD15);

Youan Specialist Medical Alliance for Liver and Infectious Diseases Special Fund (LM202028)

More Information

Corresponding author: ZHANG Mingxin， zmx3115@xiyi.edu.cn （ORCID： 0000-0002-3945-3387）

摘要

摘要: 肝硬化是各种慢性肝病的终末阶段，主要的临床表现为门静脉高压，其发生可导致自发性门体分流（SPSS）。SPSS在临床上多见，并且与患者预后息息相关。本文总结了近年来研究肝硬化门静脉高压伴SPSS的临床意义、研究中所存争议、当前治疗现状以及未来展望与挑战，为门静脉高压的规范化诊治提供参考。
- 肝硬化 /
- 高血压，门静脉 /
- 自发性门体分流
Abstract: Liver cirrhosis is the terminal stage of various chronic liver diseases， with the main clinical manifestation of portal hypertension， which can lead to spontaneous portosystemic shunt （SPSS）. SPSS is very common in clinical practice and is closely associated with the prognosis of patients. This article summarizes the recent studies in the clinical significance of cirrhotic portal hypertension with SPSS， the controversies in studies， and the current status and future prospects and challenges of treatment， in order to provide a reference for the standardized diagnosis and treatment of portal hypertension.
- Liver Cirrhosis /
- Hypertension， Portal /
- Spontaneous Portosystemic Shunt

HTML全文

注： a，常见SPSS解剖示意图；b，SPSS发展变化及血流示意图；c，经颈静脉肝内门体分流术（TIPS）/内镜治疗联合SPSS封堵示意图；d，封堵SPSS血流变化示意图。

图 1 肝硬化SPSS及血流变化示意图

Figure 1. Schematic diagram of spontaneous portal system shunt and blood flow changes in cirrhosis

下载: 全尺寸图片幻灯片

参考文献(36)

[1]	TANG SH, ZENG WZ, WU XL, et al. Formation of collateral circulation in patients with cirrhotic portal hypertension and its clinical significance[J]. J Clin Hepatol, 2016, 32( 8): 1613- 1616. DOI: 10.3969/j.issn.1001-5256.2016.08.043. 汤善宏, 曾维政, 吴晓玲, 等. 肝硬化门静脉高压侧支循环的形成及临床意义[J]. 临床肝胆病杂志, 2016, 32( 8): 1613- 1616. DOI: 10.3969/j.issn.1001-5256.2016.08.043.
[2]	ZHOU LL, ZHANG CQ. Association between collateral circulation and gastroesophageal varices in portal hypertension[J]. J Clin Hepatol, 2023, 39( 9): 2210- 2216. DOI: 10.3969/j.issn.1001-5256.2023.09.027. 周丽丽, 张春清. 门静脉高压侧支循环与食管胃静脉曲张的关系[J]. 临床肝胆病杂志, 2023, 39( 9): 2210- 2216. DOI: 10.3969/j.issn.1001-5256.2023.09.027.
[3]	NICOARĂ-FARCĂU O, WANG XZ, LUO XF. Definition of SPSS: We need to speak the same language[J]. J Hepatol, 2020, 73( 2): 463- 464. DOI: 10.1016/j.jhep.2020.03.012.
[4]	PRAKTIKNJO M, SIMÓN-TALERO M, RÖMER J, et al. Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis[J]. J Hepatol, 2020, 72( 6): 1140- 1150. DOI: 10.1016/j.jhep.2019.12.021.
[5]	WANG Y. The mechanism and clinical study of intrahepatic angiogenesis in cirrhosis with portal hypertension[D]. Jinan: Shandong University, 2019. 王乐. 肝内血管再生在肝硬化门静脉高压中的作用机制及临床研究[D]. 济南: 山东大学, 2019.
[6]	LIU YM, CHEN SY. Research progress of anti-angiogenesis therapy for portal hypertension[J/CD]. Chin J Liver Dis Electron Version, 2012, 4( 1): 59- 62. DOI: 10.3969/j.issn.1674-7380.2012.01.017. 刘以梅, 陈世耀. 门静脉高压的抗血管生成治疗研究进展[J/CD]. 中国肝脏病杂志(电子版), 2012, 4( 1): 59- 62. DOI: 10.3969/j.issn.1674-7380.2012.01.017.
[7]	WANG YG, MA XL. Current status and progress of drug therapy for portal hypertension in China[J/CD]. Chin J Digest Med Imageol: Electronic Edition, 2019, 9( 6): 248- 251. DOI: 10.3877/cma.j.issn.2095-2015.2019.06.003. 王义国, 马新力. 我国肝硬化门静脉高压症药物治疗现状及进展[J/CD]. 中华消化病与影像杂志(电子版), 2019, 9( 6): 248- 251. DOI: 10.3877/cma.j.issn.2095-2015.2019.06.003.
[8]	SIMÓN-TALERO M, ROCCARINA D, MARTÍNEZ J, et al. Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis[J]. Gastroenterology, 2018, 154( 6): 1694- 1705. e 4. DOI: 10.1053/j.gastro.2018.01.028.
[9]	QIAN SJ, WU H. Hepatic encephalopathy: Modern views on the treatment of abnormal portosystemic shunt[J]. J Clin Hepatol, 2021, 37( 12): 2774- 2777. DOI: 10.3969/j.issn.1001-5256.2021.12.007. 钱帅杰, 吴浩. 肝性脑病: 异常门体分流处理的现代观[J]. 临床肝胆病杂志, 2021, 37( 12): 2774- 2777. DOI: 10.3969/j.issn.1001-5256.2021.12.007.
[10]	RAJESH S, PHILIPS CA, AHAMED R, et al. Friend or foe? Spontaneous portosystemic shunts in cirrhosis-current understanding and future prospects[J]. Can J Gastroenterol Hepatol, 2021, 2021: 8795115. DOI: 10.1155/2021/8795115.
[11]	NARDELLI S, RIGGIO O, GIOIA S, et al. Spontaneous porto-systemic shunts in liver cirrhosis: Clinical and therapeutical aspects[J]. World J Gastroenterol, 2020, 26( 15): 1726- 1732. DOI: 10.3748/wjg.v26.i15.1726.
[12]	TAKASHI M, IGARASHI M, HINO S, et al. Esophageal varices: Correlation of left gastric venography and endoscopy in patients with portal hypertension[J]. Radiology, 1985, 155( 2): 327- 331. DOI: 10.1148/radiology.155.2.3983381.
[13]	RIGGIO O, EFRATI C, CATALANO C, et al. High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: A case-control study[J]. Hepatology, 2005, 42( 5): 1158- 1165. DOI: 10.1002/hep.20905.
[14]	TARANTINO G, CITRO V, CONCA P, et al. What are the implications of the spontaneous spleno-renal shunts in liver cirrhosis?[J]. BMC Gastroenterol, 2009, 9: 89. DOI: 10.1186/1471-230X-9-89.
[15]	DAJTI E, RENZULLI M, COLECCHIA A, et al. Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients[J]. Dig Liver Dis, 2022, 54( 1): 103- 110. DOI: 10.1016/j.dld.2020.12.114.
[16]	Hepatobiliary Disease Study Group, Chinese Society of Gastroenterology, Chinese Medical Association. Consensus for management of portal vein thrombosis in liver cirrhosis(2020, Shanghai)[J]. J Clin Hepatol, 2020, 36( 12): 2667- 2674. DOI: 10.3969/j.issn.1001-5256.2020.12.0073. 中华医学会消化病学分会肝胆疾病学组. 肝硬化门静脉血栓管理专家共识(2020年, 上海)[J]. 临床肝胆病杂志, 2020, 36( 12): 2667- 2674. DOI: 10.3969/j.issn.1001-5256.2020.12.0073.
[17]	LIU Y. Relationship between CT features of spontaneous portosystemic shunt and complications of liver cirrhosis[D]. Changchun: Jilin University, 2022. 柳瑶. 自发性门体分流的CT影像特征与肝硬化并发症的关系[D]. 长春: 吉林大学, 2022.
[18]	OHNISHI K, SATO S, SAITO M, et al. Clinical and portal hemodynamic features in cirrhotic patients having a large spontaneous splenorenal and/or gastrorenal shunt[J]. Am J Gastroenterol, 1986, 81( 6): 450- 455.
[19]	RATHI S, BROCCO S, FORMENTIN C, et al. Spontaneous portosystemic shunts in cirrhosis: Detection, implications, and clinical associations[J]. Dig Liver Dis, 2021, 53( 11): 1468- 1475. DOI: 10.1016/j.dld.2020.11.020.
[20]	ZHANG J. Comparison of clinical characteristics and prognosis of patients with liver cirrhosis with spontaneous portal system shunt[D]. Changsha: Central South University, 2023. 张洁. 肝硬化伴自发性门体分流患者的临床特征及预后分析[D]. 长沙: 中南大学, 2023.
[21]	WU WB, HAN GH. Embolization of spontaneous portosystemic shunt for cirrhotic patients with portal hypertension: A review of current status[J]. J Clin Hepatol, 2015, 31( 9): 1528- 1531. DOI: 10.3969/j.issn.1001-5256.2015.09.042.
[22]	KANAGAWA H, MIMA S, KOUYAMA H, et al. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration[J]. J Gastroenterol Hepatol, 1996, 11( 1): 51- 58. DOI: 10.1111/j.1440-1746.1996.tb00010.x.
[23]	HIROTA S, MATSUMOTO S, TOMITA M, et al. Retrograde transvenous obliteration of gastric varices[J]. Radiology, 1999, 211( 2): 349- 356. DOI: 10.1148/radiology.211.2.r99ma25349.
[24]	ZHANG HW, LIU JT, SUN G. Clinical management of portal hypertension with spontaneous portaosystemic shunt: Value of interventional radiology[J]. Chin J Pract Intern Med, 2022, 42( 10): 815- 819. DOI: 10.19538/j.nk2022100106. 张瀚文, 刘江涛, 孙刚. 合并自发性门体分流道的门静脉高压临床处置: 介入放射技术的价值[J]. 中国实用内科杂志, 2022, 42( 10): 815- 819. DOI: 10.19538/j.nk2022100106.
[25]	TRIPATHI D, BUREAU C. Prophylactic embolization of large spontaneous portosystemic shunts with transjugular intrahepatic portosystemic shunt(TIPS): A panacea for post-TIPS hepatic encephalopathy?[J]. Hepatology, 2022, 76( 3): 551- 553. DOI: 10.1002/hep.32525.
[26]	VIDAL-GONZÁLEZ J, MARTÍNEZ J, MULAY A, et al. Evolution of spontaneous portosystemic shunts over time and following aetiological intervention in patients with cirrhosis[J]. JHEP Rep, 2024, 6( 2): 100977. DOI: 10.1016/j.jhepr.2023.100977.
[27]	WENG CZ, WANG C, ZHANG J, et al. The clinical characteristics of patients with spontaneous portalsystemic shunt and isolated gastric variceal bleeding[J]. Chin Hepatol, 2024, 29( 2): 157- 161. DOI: 10.14000/j.cnki.issn.1008-1704.2024.02.007. 翁成钊, 王超, 张峻, 等. 伴自发性门静脉分流孤立性静脉曲张破裂出血患者临床特点[J]. 肝脏, 2024, 29( 2): 157- 161. DOI: 10.14000/j.cnki.issn.1008-1704.2024.02.007.
[28]	WANG F, LIU SQ, ZENG X, et al. Research on vascular occlusion therapy in gastroesophageal varices with spontaneous shunt[J]. Chin J Gastroenterol Hepatol, 2018, 27( 3): 346- 350, 355. DOI: 10.3969/j.issn.1006-5709.2018.03.024. 王芳, 刘仕倩, 曾西, 等. 食管胃底静脉曲张伴自发性分流血管栓塞治疗的研究进展[J]. 胃肠病学和肝病学杂志, 2018, 27( 3): 346- 350, 355. DOI: 10.3969/j.issn.1006-5709.2018.03.024.
[29]	ZHANG WH, LIU Y, WANG YL. Effect of modified balloon occlusion combined with endoscopic tissue adhesive embolization on gastric varices with gastrorenal shunt[J]. J Pract Med, 2022, 38( 14): 1847- 1850. DOI: 10.3969/j.issn.1006-5725.2022.14.026. 张文辉, 刘影, 王艳玲. 改良球囊封堵逆行静脉闭塞术联合胃镜下组织黏合剂栓塞术治疗胃静脉曲张伴胃肾分流的疗效[J]. 实用医学杂志, 2022, 38( 14): 1847- 1850. DOI: 10.3969/j.issn.1006-5725.2022.14.026.
[30]	BHAT YM, WEILERT F, FREDRICK RT, et al. EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years(with video)[J]. Gastrointest Endosc, 2016, 83( 6): 1164- 1172. DOI: 10.1016/j.gie.2015.09.040.
[31]	TANG YF, JIANG ZY, LONG D, et al. Efficacy of endoscopic ultrasound-guided coil placement combined with tissue adhesive injection in treatment of gastric varices with spontaneous shunt[J]. J Clin Hepatol, 2024, 40( 4): 739- 744. DOI: 10.12449/JCH240416. 汤雅芬, 蒋智洋, 龙丹, 等. 超声内镜引导下置入弹簧圈联合组织胶注射治疗合并自发性分流的胃静脉曲张的效果分析[J]. 临床肝胆病杂志, 2024, 40( 4): 739- 744. DOI: 10.12449/JCH240416.
[32]	KE Q, HE J, HUANG XH, et al. Spontaneous portosystemic shunts outside the esophago-gastric region: Prevalence, clinical characteristics, and impact on mortality in cirrhotic patients: A systematic review and meta-analysis[J]. Eur J Intern Med, 2023, 112: 77- 85. DOI: 10.1016/j.ejim.2023.03.024.
[33]	ZHANG H, LIU ZH, WANG Q, et al. Comparison of diagnostic efficacy of different dimensional imaging measurement of spontaneous portosystemic shunt in liver cirrhosis[J]. J Clin Radiol, 2024, 43( 5): 753- 758. DOI: 10.3969/j.issn.1001-5256.2021.10.037. 张欢, 刘振河, 王倩, 等. 不同维度影像测量肝硬化自发性门体分流的诊断效能比较[J]. 临床放射学杂志, 2024, 43( 5): 753- 758. DOI: 10.3969/j.issn.1001-5256.2021.10.037.
[34]	REN JZ. Clinical characteristics of patients with spleen-kidney or stomach-kidney shunt due to liver cirrhosis and endoscopic treatment of gastric varices[D]. Jinan: Shandong University, 2021. 任金正. 肝硬化脾肾或胃肾分流患者临床特点及合并胃静脉曲张内镜下治疗[D]. 济南: 山东大学, 2021.
[35]	CHEN ZP. The influence of the patent paraumbilical vein on rebleeding after endoscopic therapy of esophageal varices: a retrospective study[D]. Xian: Air Force Medical University of PLA, 2022. 陈智鹏. 附脐静脉开放对肝硬化食管胃静脉曲张二级预防内镜治疗术后再出血影响研究[D]. 西安: 中国人民解放军空军军医大学, 2022.
[36]	XU QY, CHEN HQ, XU YB, et al. Clinical value of endoscopic clipping assisted tissue adhesive combined with lauromacrogol for gastric varices with spontaneous gastrorenal shunt or splenorenal shunt[J]. China J Endosc, 2019, 25( 10): 78- 83. DOI: 10.3969/j.issn.1007-1989.2019.10.014. 许秋泳, 陈和清, 许耀斌, 等. 内镜下钛夹辅助组织胶联合聚桂醇治疗合并胃肾或脾肾分流道的胃底静脉曲张[J]. 中国内镜杂志, 2019, 25( 10): 78- 83. DOI: 10.3969/j.issn.1007-1989.2019.10.014.