Armonis A, Patch D, Burroughs A
Royal Free Hospital, London, UK.
Ital J Gastroenterol. 1996 Jun;28(5):272-9.
Variceal and portal pressure measurements are currently the most widely used invasive techniques for the haemodynamic evaluation of portal hypertension in cirrhotic patients. Variceal pressure can be measured during endoscopy either directly by variceal puncture or indirectly by using a pressure sensitive gauge. More recently, an indirect technique which uses a plastic balloon attached to the end of the endoscope has been described. Variceal pressure appears to be an important risk factor for the occurrence of variceal haemorrhage as most studies concluded that variceal pressure tends to be higher in patients with previous bleeding than those without. Hepatic venous catheterization with measurements of the wedged and free hepatic pressures has become the method of choice in the estimation of portal pressure as it is a simple, fast and safe procedure, less invasive and more reproducible than the other techniques. Information obtained from hepatic vein catheterization gives a significant prognostic value in predicting survival. Despite the lack of a linear relationship between portal pressure and risk of variceal bleeding most prospective studies have concluded that the height of portal pressure is an important and independent predictive factor for bleeding. Hepatic venous catheterization is currently the best method of assessing the haemodynamic response to drug treatment and prediction of therapeutic response for the prevention of bleeding.
目前，曲张静脉和门静脉压力测量是肝硬化患者门静脉高压血流动力学评估中应用最广泛的侵入性技术。在内镜检查期间，可通过曲张静脉穿刺直接测量曲张静脉压力，也可使用压力敏感计间接测量。最近，有人描述了一种间接技术，即使用附着在内镜末端的塑料气球。曲张静脉压力似乎是曲张静脉出血发生的一个重要危险因素，因为大多数研究得出结论，既往有出血的患者曲张静脉压力往往高于无出血患者。通过测量肝静脉楔压和自由肝静脉压进行肝静脉插管，已成为评估门静脉压力的首选方法，因为它是一种简单、快速且安全的操作，比其他技术侵入性小且更具可重复性。从肝静脉插管获得的信息在预测生存率方面具有重要的预后价值。尽管门静脉压力与曲张静脉出血风险之间缺乏线性关系，但大多数前瞻性研究得出结论，门静脉压力高度是出血的一个重要且独立的预测因素。肝静脉插管目前是评估药物治疗血流动力学反应以及预测预防出血治疗反应的最佳方法。
