我国门静脉高压症外科治疗的现况和展望

杨镇

doi:10.3969/j.issn.1001-5256.2016.02.010

我国门静脉高压症外科治疗的现况和展望

DOI: 10.3969/j.issn.1001-5256.2016.02.010

杨镇

华中科技大学同济医学院附属同济医院外科

详细信息

中图分类号: R657.34
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出版历程
- 收稿日期: 2015-10-08
- 出版日期: 2016-02-20

Current status and perspectives of surgical treatment of portal hypertension

Yang Zhen

Department of Surgery,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology

摘要

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。
- 肝硬化 /
- 门静脉高压 /
- 外科手术 /
- 腹腔镜检查
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.
- liver cirrhosis /
- portal hypertension /
- surgical procedures,operative /
- laparoscopy

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参考文献(17)

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