Current status and perspectives of surgical treatment of portal hypertension
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摘要: 门静脉高压症外科曾引领现代外科的发展。然而,在过去的1020年里,筛查和控制食管胃曲张静脉破裂出血的药物、曲张静脉套扎和经颈静脉肝内门体分流术等非手术疗法获得广泛应用。手术治疗只适用于内镜疗法无效、肝功能Child-Pugh A级的患者。目前公认可取的3种手术是远端脾肾分流术、广泛的贲门周围离断术加脾切除术和二阶段经胸腹联合断流术。由于在中国供肝短缺,因此肝移植难以普及。腹腔镜脾切除以及腹腔镜脾切除联合贲门周围血管离断术对肝硬化门静脉高压症患者乃是重大挑战。认为外科治疗门静脉高压症应与非手术疗法合作,从而对肝硬化和非肝硬化门静脉高压症患者采取个体化治疗方案。Abstract: The surgical treatment of portal hypertension once guided the development of modern surgery. In the past 10- 20 years,the non-surgical therapies including drugs to screen and control esophagogastric variceal bleeding,endoscopic variceal ligation,and transjugular intrahepatic portosystemic shunt have been widely applied in clinical practice. Surgical treatment is only applicable to those patients who do not respond to endoscopic treatment and have Child- Pugh class A liver function. At present,the following three surgeries have been universally acknowledged: distal splenorenal shunt,extensive pericardial devascularization combined with splenectomy,and two- stage transthoracic transabdominal combined devascularization. Due to a lack of liver donors in China,liver transplantation cannot be widely applied. Laparoscopic splenectomy and laparoscopic splenectomy combined with pericardial devascularization are great challenges for patients with cirrhotic portal hypertension. The author thinks that the surgical treatment of portal hypertension should collaborate with non- surgical therapies to develop individualized treatment regimens for patients with liver cirrhosis and non- cirrhotic portal hypertension.
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Key words:
- liver cirrhosis /
- portal hypertension /
- surgical procedures,operative /
- laparoscopy
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[1]MERCADO MA.Surgical treatment for portal hypertension[J].Br J Surg,2015,102(7):717-718. [2]ORLOFF MJ,HYE RJ,WHEELER HO,et al.Randomized trials of endoscopic therapy and transjugular intrahepatic portosystemic shunt versus portacaval shunt for emergency and elective treatment of bleeding gastric varices in cirrhosis[J].Surgery,2015,157(6):1028-1045. [3]ORLOFF MJ,ORLOFF MS,ORLOFF SL,et al.Unshuntable extrahepatic portal hypertension revisited:43 years'experience with radical esophagogastrectomy treatment of bleeding esophagogastric varices[J].Am J Surg,2014,207(1):46-52. [4]de FRANCHIS R,BavenoⅥFaculty.Expanding consensus in portal hypertension:report of the BavenoⅥConsensus Workshop:stratifying risk and individualizing care for portal hypertension[J].J Hepatol,2015,63(3):743-752. [5]PARK JK,SAAB S,KEE ST,et al.Balloon-occluded retrograde transvenous obliteration(BRTO)for treatment of gastric varices:review and meta-analysis[J].Dig Dis Sci,2015,60(6):1543-1553. [6]MCKIERNAN P,ABDEL-HADY M.Advances in the management of childhood portal hypertension[J].Expert Rev Gastroenterol Hepatol,2015,9(5):575-583. [7] YANG Z.Illustration of hepatic surgery[M].Shanghai:Shanghai Science and Technology Press,2009.(in Chinese)杨镇.肝脏外科学图解[M].上海:上海科学技术出版社,2009. [8]BOYER TD,HABIB S.Big spleens and hypersplenism:fix it or forget it?[J].Liver Int,2015,35(5):1492-1498. [9]MARTINS GL,BERNARDES JP,ROVELLA MS,et al.Radiofrequency ablation for treatment of hypersplenism:a feasible therapeutic option[J].World J Gastroentero,2015,21(20):6391-6397. [10]DELAITRE B,MAIGNIEN B,ICARD PH.Laparoscopic splenectomy[J].Br J Surg,1992,79(12):1334. [11]KAWANAKA H,AKAHOSHI T,KINJO N,et al.Laparoscopic splenectomy with technical standardization and selection criteria for standard or hand-assisted approach in 390 patients with liver cirrhosis and portal hypertension[J].J Am Coll Surg,2015,221(2):354-366. [12]CORCIONE F,BRACALE U,PIROZZI F,et al.Robotic single-access splenectomy using the Da Vinci Single-Site(R)platform:a case report[J].Int J Med Robot,2014,10(1):103-106. [13]MATHAROO GS,AFTHINOS JN,GIBBS KE.Trends in splenectomy:where does laparoscopy stand?[J].JSLS,2014,18(4).pii:e2014.00239. [14]HABERMALZ B,SAUERLAND S,DECKER G,et al.Laparoscopic splenectomy:the clinical practice guidelines of the European Association for Endoscopic Surgery(EAES)[J].Surg Endosc,2008,22(4):821-848. [15]FILICORI F,STOCK C,SCHWEITZERAD,et al.Three-Dimensional CT volumetry predicts outcome of laparoscopic splenectomy for splenomegaly:retrospective clinical study[J].World J Surg,2013,37(1):52-58. [16]KAWANAKA H,AKAHOSHI T,ITOH S,et al.Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombinⅢconcentrates and danaparoid sodium in liver cirrhosis with portal hypertension[J].J Am Coll Surg,2014,219(5):865-874. [17]YANG Z.Thoughts on acceleration of the development of experimental surgery and translational medicine in China[J].Chin J Exp Surg,2015,32(7):1491-1493.(in Chinese)杨镇.进一步加快我国实验外科和转化医学发展的思考[J].中华实验外科杂志,2015,32(7):1491-1493.
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