中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (05): 382-384.

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门静脉高压症治疗方法合理选择与评价

李宏为周光文   

  1. 上海交通大学医学院附属瑞金医院外科 上海消化外科研究所, 上海200025
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-05-13 发布日期:2009-05-13

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-05-13 Published:2009-05-13

摘要:

门静脉高压症的治疗方法较多,主要是针对其最严重的并发症——食管胃底静脉曲张破裂出血。目前达成的共识是出血的当时以非手术治疗即药物、内镜和介入治疗为主,应严格掌握各种治疗方式的适应证。手术治疗主要为断流、分流和肝移植三种手术方式,虽然肝移植是惟一有效的治疗手段。鉴于我国的经济和地域差异,传统手术方式仍将占据主导地位,但手术方式选择不影响今后行肝移植为先决条件。经颈静脉肝内门体分流术(TIPS)是等待肝移植的桥梁。病人的肝脏功能储备是决定生存时间长短的最重要因素。

关键词: 门静脉高压症, 经颈静脉肝内门体分流术, 肝移植

Abstract:

Reasonable choice of therapies for portal hypertension and the evaluation of its curative effects LI Hong-wei, ZHOU Guang-wen. Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China Abstract Although there are several types of treatment approaches for portal hypertension, its main goal has been to control gastroesphageal variceal bleeding. It is generally accepted that the non-surgical approaches such as drugs, endoscopy and intervention should be adopted when acute bleeding occurred and the indications of various approaches should be strictly managed. The surgical approaches include devasculation, shunting and liver transplantation. While liver transplantation has been the only effective treatment method, traditional surgical approaches such as devasculation and shunting still lie the occupying position for a long-term in the future due to the difference in economy and regions. It is requisite that the choice of surgical approaches should not be able to affect liver transplantation in the future. TIPS is a bridge between controlling bleeding and liver transplantation. The reservation of liver function would decide the survival time in patients with cirrhotic portal hypertension.

Key words: portal hypertension, transjugular intrahepatic portosystemic shunt, liver transplantation