门脉高压性胆道病的诊疗进展

Progress in Diagnosis and Treatment of Por-tal Hypertensive Biliopathy

门脉高压性胆道病(PHB)是指在肝外门静脉高压症患者中观察到的胆道异常。虽然大多数患者无症状,但这些患者中约有30%存在胆道症状(腹痛、发热、黄疸、胆管炎以及由门静脉高压引起的上消化道出血等)。PHB的发病机制至今尚不明确,但扩张的静脉压迫胆总管或周围可能起主要作用。彩色多普勒超声、电子计算机断层扫描(CT)、磁共振胆胰管成像(MRCP)和磁共振门静脉成像应是评价PHB的主要诊断方法。治疗仅限于有症状的病例,并强调其个体化治疗。PHB的治疗可通过内窥镜或外科手术(必要时通过门体分流术进行明确减压,然后进行胆肠吻合术)进行。本文将对门脉高压性胆道病的发病机制、临床特点、诊断以及治疗策略的研究进展加以文献回顾分析。

Portal hypertensive biliopathy (PHB) is a biliary abnormality observed in patients with extrahepat-ic portal hypertension. Although most patients are asymptomatic, about 30% of these patients have biliary symptoms (abdominal pain, fever, jaundice, cholangitis and upper gastrointestinal bleeding caused by portal hypertension). The pathogenesis of PHB is still unclear, but dilated veins pressing on or around the common bile duct may play a major role. Color Doppler ultrasound, computer to-mography (CT), magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance portography should be the main diagnostic methods for evaluating PHB. Treat- ment is limited to symptomatic cases, and individualized treatment is emphasized. PHB can be treated by endoscopy or surgery (definite decompression through portosystemic shunt if necessary, followed by chole-dochojejunostomy). In this paper, the pathogenesis, clinical features, diagnosis and treatment strategies of portal hypertensive biliary disease were reviewed and analyzed.