精准外科时代门静脉高压症的外科治疗策略

Surgical strategies of portal hypertension in the era of the precision surgery

门静脉高压症最危重的并发症是食管静脉曲张破裂出血。药物治疗和内镜套扎是食管静脉曲张出血的一线治疗方法，非手术治疗失败或再出血时可考虑外科手术治疗。应根据患者的病因、病期和肝功能代偿状况，依据循证医学和精准外科治疗的理念，个体化选择分流术、断流术、肝脏移植等外科手术治疗。对于某些特殊类型的非肝硬化造成的肝外型门静脉高压症，Meso—Rex转流术可作为治愈性手术方法；而对于区域性的门静脉高压症，也可能通过外科手术治愈。

Esophageal variceal hemorrhage is a severe complication of portal hypertension. Non selective-blockers and endoscopic variceal ligation have been utilized to prevent variceal hemorrhage as the first line therapeutic measures. The role of surgical approaches in the treatment of portal hypertension is still controversy. The selective shunt operation, devascularization operation, transjugular intrahepatic portosystemic shunt and liver transplantation have their own indications and limitations. Based on the precision surgical therapy, individualized selection of suitable surgical management on portal hypertension should be advocated to minimize invasiveness and cost-effect ration, maxi- mize organ saving and outcome. For patients with extrahepatic portal hypertension, Meso-Rex bypass operation could be the preventive treatment method, surgical treatment could be applied to patients with regional portal hypertension.