内镜超声在肝硬化门脉高压症诊治中的研究进展

Research progress of endoscopic ultrasound in diagnosis and treatment of cirrhosis portal hypertension

内镜超声(endoscopic ultrasound,EUS)的发展及创新扩大了其在肝脏疾病诊治中的作用,EUS不仅被广泛应用于胆胰疾病的诊治,其在肝实质和门脉系统疾病中的应用也在迅速发展。本文回顾相关文献,概述了EUS在肝硬化门脉高压症的诊断及其并发症治疗中的研究现状及前景,重点介绍EUS引导下肝活检、EUS引导下门静脉压力梯度测量及EUS引导下胃静脉曲张治疗的研究进展。目前的数据表明:EUS引导下肝活检安全有效,在取样充分性上可与传统活检方式相媲美,而且术后恢复更快、疼痛程度更低。EUS引导下门静脉压力梯度测量较肝静脉压力梯度更准确地反映以窦前性门脉高压为主疾病的门静脉压力的程度,适用疾病更广。与常规内镜相比,EUS引导下血管介入术治疗胃静脉曲张优势众多,其中EUS引导弹簧圈联合组织胶治疗比单独使用弹簧圈或组织胶治疗更有效、并发症更少。

The development and innovation of endoscopic ultrasound(EUS)have expanded its role in the diagnosis and treatment of liver diseases.EUS is not only widely used in the diagnosis and treatment of biliary and pancreatic diseases,but its application in liver parenchymal and portal system diseases is also rapidly developing.This article reviewed relevant literature,outlines the current research status and prospects of EUS in the diagnosis and treatment of liver cirrhosis with portal hypertension and its complications,and focuses on the research progress of EUS-guided liver biopsy,measurement of portal venous pressure gradient under EUS guidance,and treatment of gastric varices under EUS guidance.Current data indicates that EUS-guided liver biopsy is safe and effective,comparable to traditional biopsy methods in terms of sample adequacy,with faster postoperative recovery and lower pain levels.Measurement of portal venous pressure gradient under EUS guidance reflects the degree of portal venous pressure more accurately than hepatic venous pressure gradient,particularly for diseases primarily characterized by pre-sinusoidal portal hypertension,and is applicable to a wider range of diseases.Compared to conventional endoscopy,EUS-guided vascular intervention therapy for gastric varices has numerous advantages,with the combination of EUS-guided coil placement and tissue adhesive therapy proving more effective with fewer complications than using coils or tissue adhesive alone.