断流术在肝硬化门静脉高压中的作用及争议

徐伟; 涂兵

doi:10.3969/j.issn.1001-5256.2020.03.043

断流术在肝硬化门静脉高压中的作用及争议

DOI: 10.3969/j.issn.1001-5256.2020.03.043

徐伟,
涂兵

重庆医科大学附属第二医院肝胆外科

详细信息

中图分类号: R657.34
计量
- 文章访问数: 1005
- HTML全文浏览量: 10
- PDF下载量: 261
- 被引次数: 0
出版历程
- 收稿日期: 2019-09-19
- 出版日期: 2020-03-20

The role of devascularization in cirrhotic portal hypertension and related controversies

Xu Wei,
Tu Bing

Department of Hepatobiliary Surgery,The Second Affiliated Hospital of Chongqing Medical University

摘要

摘要: 门静脉高压所致的胃-食管静脉曲张破裂出血及脾功能亢进等严重威胁到肝硬化患者的生命。目前外科断流术仍是治疗门静脉高压的重要术式之一,但药物、内镜及介入等治疗方式的兴起,使得断流术在门静脉高压治疗中的作用、手术指征、手术时机以及脾切除与否等受到争议。对断流术的作用及争议进行阐述分析,指出目前断流术仍是不可替代的,而门静脉高压的治疗应以个体化、综合性、微创为原则,尽可能带给患者最小的创伤、最大的受益。
- 肝硬化 /
- 高血压,门静脉 /
- 食管和胃静脉曲张 /
- 断流术
Abstract: Gastroesophageal variceal bleeding and hypersplenism caused by portal hypertension seriously threaten the life of patients with liver cirrhosis. At present,devascularization is still one of the important surgical procedures for the treatment of portal hypertension; however,the development of the treatment methods such as drugs,endoscopy,and interventional treatment has caused the controversies over the role,surgical indications,and surgical timing of devascularization in the treatment of portal hypertension,as well as whether splenectomy is needed. This article reviews the role of devascularization and related controversies and points out that devascularization is still irreplaceable. Individualized,comprehensive,and minimally invasive treatment regimens should be developed for portal hypertension,so as to bring maximum benefits to patients with minimal invasiveness.
- liver cirrhosis /
- hypertension,portal /
- esophageal and gastric varices /
- devascularization

HTML全文

参考文献(29)

[1] IBRAHIM M,MOSTAFA I,DEVIERE J. New developments in managing variceal bleeding[J]. Gastroenterology,2018,154(7):1964-1969.

[2] ROBERTSON M,HAYES P. Primary prophylaxis of variceal bleeding[J]. Hepatol Int,2018,12(1):1-5.

[3] MERCADO MA. Surgical treatment for portal hypertension[J].Br J Surg,2015,102(7):717-718.

[4] HASSAB MA. Gastroesophageal decongestion and splenectomy. A method of prevention and treatment of bleeding from esophageal varices associated with bilharzial hepatic fibrosis:Preliminary report[J]. J Int Coll Surg,1964,41:232-248.

[5] LIU Y,LI Y,MA J,et al. A modified Hassab's operation for portal hypertension:Experience with 562 cases[J]. J Surg Res,2013,185(1):463-468.

[6] YANG Z,QIU F. Pericardial devascularization with splenectomy for the treatment of portal hypertension[J]. Chin J Surg,2000,38(9):645-648.

[7] SUGIURA M,FUTAGAWA S. A new technique for treating esophageal varices[J]. J Thorac Cardiovasc Surg,1973,66(5):677-685.

[8] MA YG,CHEN H,WU MC. Modified sugiura for the treatment of portal hypertension in 72 cases[J]. Chin J Gen Surg,2002,17(3):135-136.(in Chinese)马优钢，陈汉，吴孟超．改良Sugiura手术治疗门静脉高压症的疗效评价[J]．中华普通外科杂志，2002,17(3):135-136.

[9] DELAITRE B,MAIGNIEN B,ICARD P. Laparoscopic splenectomy[J]. Br J Surg,1992,79(12):1334.

[10] YANG Z. Selective pericardial devascularization[J]. J Clin Surg,2004,12(7):393-394.(in Chinese)杨镇．选择性贲门周围血管离断术[J]．临床外科杂志，2004,12(7):393-394.

[11] BAO H,HE Q,DAI N,et al. Retrospective study to compare selective decongestive devascularization and gastrosplenic shunt versus splenectomy with pericardial devascularization for the treatment of patients with esophagogastric varices due to cirrhotic portal hypertension[J]. Med Sci Monit,2017,23:2788-2795.

[12] Study Group of Portal Hypertension,Chinese Society of Surgery,Chinese Medical Association. Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension(2015 edition)[J]. Chin J Surg,2015,53(12):917-921.(in Chinese)中华医学会外科学分会门静脉高压学组．肝硬化门静脉高压症食管、胃底静脉曲张破裂出血的诊治共识(2015版)[J]．中华外科杂志，2015,53(12):917-921.

[13] GARCIA-TSAO G,ABRALDES JG,BERZIGOTTI A,et al.Portal hypertensive bleeding in cirrhosis:Risk stratification,diagnosis,and management:2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology,2017,65(1):310-335.

[14] Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association; Chinese Society of Endoscopy,Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol,2016,32(2):203-219.(in Chinese)中华医学会肝病学分会，中华医学会消化病学分会，中华医学会内镜学分会．肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]．临床肝胆病杂志，2016,32(2):203-219.

[15] de FRANCHIS R,BAVENO VIF. Expanding consensus in portal hypertension:Report of the Baveno VI Consensus Workshop:Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol,2015,63(3):743-752.

[16] ZHOU GW,GUAN J. Standard treatment of portal hypertension:How to understand related consensus statements and guidelines[J]. Chin J Gen Surg,2018,33(7):537-539.(in Chinese)周光文，关蛟．对门静脉高压症规范治疗的认识———如何理解共识与指南[J]．中华普通外科杂志，2018,33(7):537-539.

[17] MOHAMMED SE,ABDO AE,MUDAWI HM. Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis[J]. World J Hepatol,2016,8(31):1336-1342.

[18] DU Z,WANG YJ,NIE FH,et al. A comparison between operative devascularization and endoscopic ligation for the treatment of bleeding gastroesophageal varices in 623 patients with portal hypertension[J]. Chin J Gen Surg,2007,22(5):362-365.(in Chinese)杜智，王毅军，聂福华，等．门静脉高压症食管胃底静脉曲张出血的手术与内镜套扎的疗效分析[J]．中华普通外科杂志，2007,22(5):362-365.

[19] PAL S,MANGLA V,RADHAKRISHNA P,et al. Surgery as primary prophylaxis from variceal bleeding in patients with extrahepatic portal venous obstruction[J]. J Gastroenterol Hepatol,2013,28(6):1010-1014.

[20] GARCIA-TSAO G,SANYAL AJ,GRACE ND,et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J]. Hepatology,2007,46(3):922-938.

[21] CAO YJ,PAN YM,BAO SH,et al. Analysis of prognostic factors of portal hypertension treated with devascularization[J].Chin J Surg,2016,54(6):434-438.(in Chinese)曹亚娟，潘一明，包善华，等．断流术治疗门静脉高压症的预后影响因素分析[J]．中华外科杂志，2016,54(6):434-438.

[22] CAO JL,LU SC,ZENG DB,et al. Clinical analysis of splenectomy and selective devascularization based on intra-operative portal pressure[J]. Chin J Hepatobiliary Surg,2014,20(9):648-651.(in Chinese)曹技磊，卢实春，曾道炳，等．基于术中自由门静脉压测定的脾切除加选择性断流术的临床分析[J]．中华肝胆外科杂志，2014,20(9):648-651.

[23] BOYER TD,HABIB S. Big spleens and hypersplenism:Fix it or forget it?[J]. Liver Int,2015,35(5):1492-1498.

[24] IKEDA M,SEKIMOTO M,TAKIGUCHI S,et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy:A prospective study with contrast-enhanced CT scan[J]. Ann Surg,2005,241(2):208-216.

[25] WU J,LI Z,WANG Z,et al. Surgical and endovascular treatment of severe complications secondary to noncirrhotic portal hypertension:Experience of 56 cases[J]. Ann Vasc Surg,2013,27(4):441-446.

[26] CHENG Z,LI JW,CHEN J,et al. Therapeutic effects of laparoscopic splenectomy and esophagogastric devascularization on liver cirrhosis and portal hypertension in 204 cases[J]. J Laparoendosc Adv Surg Tech A,2014,24(9):612-616.

[27] XU X,GUO HJ,LI WY. Treatment options for portal hypertension in the era of liver transplantion[J]. Chin J Dig Surg,2018,17(10):992-996.(in Chinese)徐骁，郭海军，李望遥．肝移植时代门静脉高压症的治疗选择[J]．中华消化外科杂志，2018,17(10):992-996.

[28] BA DS,ZHANG C,JIN SJ,et al. Laparoscopic splenectomy and azygoportal disconnection combining with pre-and postoperative endoscopic intervention-A sandwich-style sequential therapy for portal hypertensive bleeding:A retrospective cohort study[J]. Turk J Gastroenterol,2018,29(6):669-675.

[29] YANG LY. Attention to the surgical treatment of portal hypertension in China[J]. Chin J Dig Surg,2018,17(10):971-975.(in Chinese)杨连粤．重视我国门静脉高压症外科治疗的问题[J]．中华消化外科杂志，2018,17(10):971-975.

施引文献

资源附件(0)

访问统计