Research advances in cirrhotic portal hypertension with spontaneous portosystemic shunt
-
摘要: 肝硬化是各种慢性肝病的终末阶段,其最主要并发症为门静脉高压,在这样病理状态下,自发性门体分流(SPSS)作为门静脉系统侧支循环,其发生机理及临床价值尚未引起足够重视。经分析表明,SPSS虽为自然分流通道,但是否作为门静脉高压的一种减压方式,尚有待进一步深入研究; 加深对SPSS的认识将为门静脉高压的诊治提供重要的指导意义。
-
关键词:
- 肝硬化 /
- 高血压, 门静脉 /
- 门体分流术, 经颈静脉肝内
Abstract: Liver cirrhosis is the end stage of various chronic liver diseases, and portal hypertension is a main complication of liver cirrhosis. In this pathological state, spontaneous portosystemic shunt (SPSS), as the collateral circulation of the portal venous system, has not attracted enough attention in terms of occurrence mechanism and clinical value. The analysis shows that although SPSS is a natural shunt channel, further studies are still needed to clarify whether it can be used as a decompression method for portal hypertension, and a deeper understanding of SPSS will provide important guiding significance for the diagnosis and treatment of portal hypertension. -
[1] HU WY, RAO CY, LIU HB, et al. A case of spontaneous portosystemic shunt with hepatic encephalopathy[J]. J Clin Hepatol, 2019, 35(3): 611-612. DOI: 10.3969/j.issn.1001-5256.2019.03.033. [2] PAQUET KJ. Causes and pathomechanisms of oesophageal varices development[J]. Med Sci Monit, 2000, 6(5): 915-928. [3] SHIGEFUKU R, IWASA M, EGUCHI A, et al. Serum copeptin level is a biomarker associated with ascites retention and the formation of a portosystemic shunt in chronic liver disease[J]. J Gastroenterol Hepatol, 2021, 36(4): 1006-1014. DOI: 10.1111/jgh.15215. [4] 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. [5] WU Q, SHEN L, CHU J, et al. Characterization of uncommon portosystemic collateral circulations in patients with hepatic cirrhosis[J]. Oncol Lett, 2015, 9(1): 347-350. DOI: 10.3892/ol.2014.2626. [6] BANDALI MF, MIRAKHUR A, LEE EW, et al. Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy[J]. World J Gastroenterol, 2017, 23(10): 1735-1746. DOI: 10.3748/wjg.v23.i10.1735. [7] ARORA A, RAJESH S, MEENAKSHI YS, et al. Spectrum of hepatofugal collateral pathways in portal hypertension: An illustrated radiological review[J]. Insights Imaging, 2015, 6(5): 559-572. DOI: 10.1007/s13244-015-0419-8. [8] MITTY HA, COHEN BA, SPRAYREGEN S, et al. Adrenal pseudotumors on CT due to dilated portosystemic veins[J]. AJR Am J Roentgenol, 1983, 141(4): 727-730. DOI: 10.2214/ajr.141.4.727. [9] GOULD HR, BENJAMIN S, ALTER AJ, et al. Retroperitoneal varices simulating masses[J]. Gastrointest Radiol, 1982, 7(4): 335-339. DOI: 10.1007/BF01887667. [10] ZONG R, YANG JY, SONG JY, et al. Multi-slice CT portal venography in demonstrating collateral circulation of portal hypertension[J]. J Chin Clin Med Imaging, 2013, 24(10): 747-749. DOI: 10.3969/j.issn.1008-1062.2013.10.020. [11] WACHSBERG RH, YAGHMAI V, JAVORS BR, et al. Cardiophrenic varices in portal hypertension: Evaluation with CT[J]. Radiology, 1995, 195(2): 553-556. DOI: 10.1148/radiology.195.2.7724782. [12] 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. e4. DOI: 10.1053/j.gastro.2018.01.028. [13] ALLARD MA, AKAMATSU N, KOKUDO T, et al. Clinical significance of spontaneous portosystemic shunts in living donor liver transplanta tion[J]. Liver Transpl, 2021, 27(1): 77-87. DOI: 10.1002/lt.25798. [14] WACHSBERG RH, BAHRAMIPOUR P, SOFOCLEOUS CT, et al. Hepatofugal flow in the portal venous system: Pathophysiology, imaging findings, and diagnostic pitfalls[J]. Radiographics, 2002, 22(1): 123-140. DOI: 10.1148/radiographics.22.1.g02ja20123. [15] SUBRAMANYAM BR, BALTHAZAR EJ, MADAMBA MR, et al. Sonography of portosystemic venous collaterals in portal hypertension[J]. Radiology, 1983, 146(1): 161-166. DOI: 10.1148/radiology.146.1.6849040. [16] SALAHSHOUR F, MEHRABINEJAD MM, RASHIDI SHAHPASANDI MH, et al. Esophageal variceal hemorrhage: The role of MDCT characteristics in predicting the presence of varices and bleeding risk[J]. Abdom Radiol (NY), 2020, 45(8): 2305-2314. DOI: 10.1007/s00261-020-02585-5. [17] BERZIGOTTI A, SEIJO S, REVERTER E, et al. Assessing portal hypertension in liver diseases[J]. Expert Rev Gastroenterol Hepatol, 2013, 7(2): 141-155. DOI: 10.1586/egh.12.83. [18] 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. [19] KUMAMOTO M, TOYONAGA A, INOUE H, et al. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: Hepatic deterioration links to portosystemic shunt syndrome[J]. J Gastroenterol Hepatol, 2010, 25(6): 1129-1135. DOI: 10.1111/j.1440-1746.2010.06262.x. [20] SAAD WE. Portosystemic shunt syndrome and endovascular management of hepatic encephalopathy[J]. Semin Intervent Radiol, 2014, 31(3): 262-265. DOI: 10.1055/s-0034-1382795. [21] SHI Q, WU Z, BAI T, et al. Clinical characteristics analysis of 30 cases of cirrhosis complicated with spontaneous spleen-renal shunt[J]. Chin J Dig, 2017, 37(10): 692-693. DOI: 10.3760/cma.j.issn.0254-1432.2017.10.009. [22] LIPINSKI M, SABOROWSKI M, HEIDRICH B, et al. Clinical characteristics of patients with liver cirrhosis and spontaneous portosystemic shunts detected by ultrasound in a tertiary care and transplantation centre[J]. Scand J Gastroenterol, 2018, 53(9): 1107-1113. DOI: 10.1080/00365521.2018.1498913. [23] 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. [24] QI XS, QI XL, ZHANG Y, et al. Prevalence and clinical characteristics of spontaneous splenorenal shunt in liver cirrhosis: A retrospective observational study based on contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) scans[J]. Med Sci Monit, 2017, 23: 2527-2534. DOI: 10.12659/msm.901656. [25] ZHAO H, TSAUO J, LI X. Percutaneous retroperitoneal splenorenal shunt: An alternative to transjugular intrahepatic portosystemic shunt?[J]. Am J Transplant, 2016, 16(1): 374. DOI: 10.1111/ajt.13563. [26] PHILIPS CA, RAJESH S, GEORGE T, et al. Early, late, or no shunt embolization in patients with cirrhosis- and portosystemic shunt-related hepatic encephalopathy[J]. Indian J Gastroenterol, 2020, 39(4): 377-387. DOI: 10.1007/s12664-020-01042-x. [27] ISHIKAWA T, SASAKI R, NISHIMURA T, et al. Improved hepatic reserve and fibrosis in a case of "portal-systemic liver failure" by portosystemic shunt occlusion[J]. Am J Case Rep, 2020, 21: e921236. DOI: 10.12659/AJCR.921236. [28] PHILIPS CA, RAJESH S, AUGUSTINE P, et al. Portosystemic shunts and refractory hepatic encephalopathy: Patient selection and current options[J]. Hepat Med, 2019, 11: 23-34. DOI: 10.2147/HMER.S169024. [29] CHANG YH, ZHOU XL, JING D, et al. Portal hypertension exacerbates intrahepatic portosystemic venous shunt and further induces refractory hepatic encephalopathy: A case report[J]. World J Clin Cases, 2021, 9(2): 496-501. DOI: 10.12998/wjcc.v9.i2.496. [30] HU WY, RAO CY, LIU HB, et al. A case of spontaneous portosystemic shunt with hepatic encephalopathy[J]. J Clin Hepatol, 2019, 35(3): 611-612. DOI: 10.3969/j.issn.1001-5256.2019.03.033. [31] TAKAHASHI S, YOSHIDA E, SAKANISHI Y, et al. Congenital multiple intrahepatic portosystemic shunt: An autopsy case[J]. Int J Clin Exp Pathol, 2013, 7(1): 425-431. DOI: 10.7314/APJCP.2014.15.3.1501 [32] TSOCHATZIS EA, SENZOLO M, GERMANI G, et al. Systematic review: Portal vein thrombosis in cirrhosis[J]. Aliment Pharmacol Ther, 2010, 31(3): 366-374. DOI: 10.1111/j.1365-2036.2009.04182.x. [33] European Association for the Study of the Liver. EASL clinical practice guidelines: Vascular diseases of the liver[J]. J Hepatol, 2016, 64(1): 179-202. DOI: 10.1016/j.jhep.2015.07.040. [34] GARCÍA-PAGÁN JC, CACA K, BUREAU C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding[J]. N Engl J Med, 2010, 362(25): 2370-2379. DOI: 10.1056/NEJMoa0910102. [35] WANG T, LI MS, HAN QR, et al. Analysis of the incidence and prognosis of spontaneous portosystemic shunt in patients with cirrhosis[J]. Chin Hepatol, 2020, 25(9): 948-951. DOI: 10.14000/j.cnki.issn.1008-1704.2020.09.017. [36] WAN YM, LI YH, XU ZY, et al. Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding[J]. Eur Radiol, 2019, 29(9): 5032-5041. DOI: 10.1007/s00330-019-06046-6.
本文二维码
计量
- 文章访问数: 838
- HTML全文浏览量: 425
- PDF下载量: 149
- 被引次数: 0