应重视门静脉高压症的病因诊断及规范治疗

Etiological diagnosis and standard treatment of portal hypertension should be taken seriously

门静脉高压症是由门静脉系统阻力/血流增加或肝静脉系统回流受阻所导致的门静脉压力异常升高,常表现为脾大、脾功能亢进、食管胃静脉曲张及破裂出血、腹水及肝性脑病等。肝硬化所引起的窦性门静脉高压症临床最为常见,通常伴有肝脏合成功能障碍。而肝外、肝内门静脉系统异常所致的肝(窦)前门静脉高压,以及肝内、肝外肝静脉系统回流受阻所致的肝(窦)后性门静脉高压,多无明显肝脏合成功能障碍。可首先根据临床症状、体征及血液学指标判断有无门静脉高压症,再通过影像学、肝静脉压力梯度及组织病理学检查明确其类型和病因。应在积极治疗原发病的基础上,采取非选择性β受体阻断剂、内镜、介入或手术治疗,以防治门静脉高压症的并发症。

Portal hypertension( PH) referes to an abnormal increase in portal venous pressure due to increased resistance and/or blood flow of the portal vein or backflow obstruction of the hepatic veins and often manifests as splenomegaly,hypersplenism,gastroesophageal varices and bleeding,ascites,and hepatic encephalopathy. Liver synthetic dysfunction is often seen in sinusoidal PH caused by liver cirrhosis,while it is less often seen in pre-hepatic/pre-sinusoidal PH due to abnormalities in the extrahepatic and intrahepatic portal veins or post-hepatic/post-sinusoidal PH due to backflow obstruction of the extrahepatic and intrahepatic hepatic veins. The presence or absence of PH can be determined by clinical symptoms,signs,and hematological parameters,and type and etiology can be clarified by imaging examinations,hepatic venous pressure gradient,and histopathological features. In addition to the active treatment of primary diseases,nonselective beta-blockers,endoscopy,and interventional or surgical therapy should be used for the prevention and treatment of PH complications.