关键词: 肝硬化, 门静脉高压症, 外科治疗

Abstract:

Surgical therapy procedure in cirrhosis with portal hypertension        WU Zhi-yong, CHEN Wei. Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
Corresponding author：WU Zhi-yong, E-mail：zhiyongwu@gmail.com
Abstract    Bleeding from esophagogastric varices is the most life-threatening complication of portal hypertension, which is the main target of traditional surgical therapy. It has been reached a consensus that non-operative therapy is primary during the period of acute variceal bleeding, such as pharmacotherapy, endoscopic therapy, triplelumen tube balloon tamponade and so on. In the case of refractory bleeding, emergency operation is suitable in patients provided that the liver dysfunction is not too severe ( Child- Pugh class A or B ). Devascularization is the most suitable choice in emergency operation so long as there is hepatopetal blood flow in the portal vein. Transjugular intrahepatic portosystem shunt (TIPS) is suitable for the patients of Child-Pugh class C who are in emergency state. Most patients who survive a first variceal hemorrhage episode should receive surgical treatment to prevent recurrent episodes. The etiological factor(s) should be defined before operation, and it also should be evaluated that the hepatic functional reserve, degree of portal hypertension and hemodynamics of the liver and portal system. Mainly for the traditional surgical method includes devascularization, shunt surgery and shunt combined with devascularization surgery. We emphasize that selection of operative method must be based on portal vein hemodynamics, and the operative modality must have a definite hemodynamic status. Among those who bleed in portal hypertension, patients with only liver function Child-Pugh class C who can not be improved by medical treatment (end-stage liver disease) are suitable for liver transplantation.

Key words: cirrhosis;portal hypertension, surgical therapy