门静脉高压的外科治疗现状及进展

Surgical Treatment Status Quo and Development of Portalhypertension

传统的门静脉高压症的外科治疗主要有断流术和门体静脉分流术2大类。断流术是一类相对简便的手术，不足之处在于术后再出血率明显高于分流手术。门腔静脉侧侧分流加肝动脉强化灌注术联合术式，既能保持一定的门静脉向肝血供和提高肝动脉对肝脏的供氧量，又能疏通门静脉系统的高血流状态，故其术后并发症发生率、手术病死率和再出血率均有明显下降，疗效好。肝移植手术的出现，对彻底治愈肝硬化门静脉高压症带来了希望。但对我国大量肝炎后肝硬化、血吸虫性肝硬化并发门静脉高压症、食管胃底静脉曲张破裂出血的患者，不可能全都采用肝移植治疗。因此，传统疗法在较长时间内仍然会有用武之地。术前综合分析患者临床指标和肝功能实验室检查有助于评价肝硬化患者肝储备功能，预测手术风险及术后转归。

Traditional surgical treatments on portal hypertension include clevascularization and shunt procedure. The devascularization is a relatively simple surgical procedure. Its disadvantages exist higher recurrent bieeding rate than shunt procedure. The portacaval shunt plus enhancement of perfusion of hepatic artery, not only can maintain a certain degree of portal vein to the liver for hepatic artery and increase the oxygen supply to the liver, but also cart clear the portal vein system of high blood flow, so the incidence of post-operative compli- cations, mortality and re-bleeding rates are significantly decreased, and has good effect. The appearance of liver transplant operation, brings hope to cure completly for liver cirrhosis with portal hypertension. However, a large number of patients with liver cirrhosis,liver cirrhosis complicated by Schistosoma portal hypertension, esophageal varices bleeding in our country impossible all use liver transplantation. So, traditional therapy will still be used for a long time. The pre-operative comprehensive analysis to patients with clinical index and laboratory tests of liver function were helpful to evaluate the functional reserves of patients with liver cirrhosis, predict the risk of surgery and post-operative prognosis.