Vidal-González Judit, Quiroga Sergi, Simón-Talero Macarena, Genescà Joan
Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
Radiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Therap Adv Gastroenterol. 2020 Sep 29;13:1756284820961287. doi: 10.1177/1756284820961287. eCollection 2020.
Portal hypertension is the main consequence of liver cirrhosis, leading to severe complications such as variceal hemorrhage, ascites or hepatic encephalopathy. As an attempt to decompress the portal venous system, portal flow is derived into the systemic venous system through spontaneous portosystemic shunts (SPSSs), bypassing the liver. In this review, we aim to provide an overview of the published reports in relation to the prevalence and physiopathology behind the appearance of SPSS in liver cirrhosis, as well as the complications derived from its formation and its management. The role of SPSS embolization is specifically discussed, as SPSSs have been assessed as a therapeutic target, mainly for patients with recurrent/persistent hepatic encephalopathy and preserved liver function. Furthermore, different aspects of the role of SPSS in liver transplantation, as well as in candidates for transjugular intrahepatic portosystemic shunt are reviewed. In these settings, SPSS occlusion has been proposed to minimize possible deleterious effects, but results are so far inconclusive.
门静脉高压是肝硬化的主要后果，可导致严重并发症，如静脉曲张出血、腹水或肝性脑病。作为一种试图减轻门静脉系统压力的方法，门静脉血流通过自发性门体分流（SPSS）进入体循环静脉系统，绕过肝脏。在本综述中，我们旨在概述已发表的有关肝硬化中SPSS出现的患病率和病理生理学，以及其形成所导致的并发症及其管理的报告。特别讨论了SPSS栓塞的作用，因为SPSS已被评估为一种治疗靶点，主要针对复发性/持续性肝性脑病且肝功能保留的患者。此外，还综述了SPSS在肝移植以及经颈静脉肝内门体分流术候选者中的作用的不同方面。在这些情况下，有人提出闭塞SPSS以尽量减少可能的有害影响，但迄今为止结果尚无定论。
