Wright Andrew S, Rikkers Layton F
Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA.
J Gastrointest Surg. 2005 Sep-Oct;9(7):992-1005. doi: 10.1016/j.gassur.2004.09.028.
Portal hypertension can lead to life-threatening hemorrhage, ascites, and encephalopathy. This paper reviews the pathophysiology and multidisciplinary management of portal hypertension and its complications, including the indications for and techniques of the various surgical shunts. Variceal bleeding is the most dreaded complication of portal hypertension. It may occur once the portal-systemic gradient increases above 12 mm Hg, occurs in 30% of patients with cirrhosis, and carries a 30-day mortality of 20%. Treatment of acute variceal bleeding includes resuscitation followed by upper endoscopy for sclerosis or band ligation of varices, which can control bleeding in up to 85% of patients. Medical therapies such as vasopressin and somatostatin can also be useful adjuncts. Shunt therapy, preferably the placement of a TIPS, is indicated for refractory acute variceal bleeding. Recurrent variceal bleeding is common and is associated with a high mortality. Therapies to prevent recurrent variceal bleeding include chronic endoscopic therapy, nonselective beta-blockade, operative or nonoperative (TIPS) shunts, devascularization operations, and liver transplantation. Recommendations and a treatment algorithm are provided, taking into account both the etiology and the manifestations of portal hypertension.
门静脉高压可导致危及生命的出血、腹水和肝性脑病。本文综述了门静脉高压及其并发症的病理生理学和多学科管理，包括各种外科分流术的适应证和技术。静脉曲张出血是门静脉高压最可怕的并发症。当门静脉-体循环压力梯度升高超过12 mmHg时可能发生，在30%的肝硬化患者中出现，30天死亡率为20%。急性静脉曲张出血的治疗包括复苏，随后进行上消化道内镜检查以硬化或结扎静脉曲张，这可控制高达85%患者的出血。血管加压素和生长抑素等药物治疗也可作为有用的辅助治疗。分流治疗，最好是放置经颈静脉肝内门体分流术（TIPS），适用于难治性急性静脉曲张出血。复发性静脉曲张出血很常见，且死亡率高。预防复发性静脉曲张出血的治疗方法包括慢性内镜治疗、非选择性β受体阻滞剂、手术或非手术（TIPS）分流术、去血管化手术和肝移植。本文综合考虑门静脉高压的病因和表现，提供了相关建议和治疗方案。
