Recent advances in promising drugs for primary prevention of gastroesophageal variceal bleeding with cirrhotic portal hypertension

Background:Gastroesophageal variceal bleeding is one of the most severe complications of patients with cirrhosis.Although primary prevention drugs,including non-selectiveβ-blockers,have effectively reduced the incidence of bleeding,their efficacy is limited due to side effects and related contraindications.With recent advances in precision medicine,precise drug treatment provides better treatment efficacy.Data sources:Literature search was conducted in PubMed,MEDLINE and Web of Science for relevant articles published up to May 2022.Information on clinical trials was obtained from https://clinicaltrials.gov/and http://www.chictr.org.cn/.Results:The in-depth understanding of the pathogenesis and advances of portal hypertension has enabled the discovery of multiple molecular targets for promising drugs.According to the site of action,these drugs could be classified into four classes:intrahepatic,extrahepatic,both intrahepatic and extrahepatic targets and others.All these classes of drugs offer advantages over traditional treatments in prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.Conclusions:This review classified and summarized the promising drugs,which prevent gastroesophageal variceal bleeding by targeting specific markers of pathogenesis of portal hypertension,demonstrating the significance of using the precision medicine strategy to discover and develop promising drugs for the primary prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.

Glucocorticoid therapy in pancreatic portal hypertension associated with autoimmune pancreatitis:A case report

BACKGROUND Autoimmune pancreatitis(AIP)is a chronic form of pancreatitis characterized by diffused enlargement of the pancreas and irregular stenosis of the main pancreatic duct.Some studies have reported that AIP can cause hemorrhage of gastric varices(GV)related to portal hypertension(PH).However,such cases are rare.In addition,the association of PH with AIP is unclear.At the same time,the efficacy and duration of glucocorticoid therapy is also controversial.CASE SUMMARY In this case,we reported a case of GV in pancreatic PH associated with AIP.Enhanced abdominal computed tomography(CT)suggested splenic vein(SV)and superior mesenteric vein(SMV)thromboses.The patient received a long-term glucocorticoid therapy,that the initial dose of 40 mg is reduced weekly by 5 mg,and then reduced to 5 mg for long-term maintenance.CT and gastroscopic examination after 8 mo of treatment indicated that SV and SMV were recanalized,pancreatic stiffness and swelling were ameliorated,and the GV almost completely disappeared.CONCLUSION Long-term glucocorticoid therapy can alleviate the development of GV in patients with AIP and has potential reversibility.

Contemporary concepts of the medical therapy of portal hypertension under liver cirrhosis

Severe complications of liver cirrhosis are mostly related to portal hypertension. At the base of the pathogenesis of portal hypertension is the increase in hepatic vascular resistance to portal blood flow with subsequent development of hyperdynamic circulation, which, despite of the formation of collateral circulation, promotes progression of portal hypertension. An important role in its pathogenesis is played by the rearrangement of vascular bed and angiogenesis. As a result, strategic directions of the therapy of portal hypertension under liver cirrhosis include selectively decreasing hepatic vascular resistance with preserving or increasing portal blood flow, and correcting hyperdynamic circulation and pathological angiogenesis, while striving to reduce the hepatic venous pressure gradient to less than 12 mm Hg or 20% of the baseline. Over the last years, substantial progress in understanding the pathophysiological mechanisms of hemodynamic disorders under liver cirrhosis has resulted in the development of new drugs for their correction. Although the majority of them have so far been investigated only in animal experiments, as well as at the molecular and cellular level, it might be expected that the introduction of the new methods in clinical practice will increase the efficacy of the conservative approach to the prophylaxis and treatment of portal hypertension complications. The purpose of the review is to describe the known methods of portal hypertension pharmacotherapy and discuss the drugs that may affect the basic pathogenetic mechanisms of its development.

Antiangiogenic therapy for portal hypertension in liver cirrhosis: Current progress and perspectives

Developing medicines for hemodynamic disorders that are characteristic of cirrhosis of the liver is a relevant problem in modern hepatology. The increase in hepatic vascular resistance to portal blood flow and subsequent hyperdynamic circulation underlie portal hypertension(PH) and promote its progression, despite the formation of portosystemic collaterals. Angiogenesis and vascular bed restructurization play an important role in PH pathogenesis as well. In this regard, strategic directions in the therapy for PH in cirrhosis include selectively decreasing hepatic vascular resistance while preserving or increasing portal blood flow, and correcting hyperdynamic circulation and pathological angiogenesis. The aim of this review is to describe the mechanisms of angiogenesis in PH and the methods of antiangiogenic therapy. The Pub Med database, the Google Scholar retrieval system, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 2000-2017 using the keywords: "liver cirrhosis", "portal hypertension", "pathogenesis", "angiogenesis", and "antiangiogenic therapy". Antiangiogenic therapy for PH was the inclusion criterion. In this review, we have described angiogenesis inhibitors and their mechanism of action in relation to PH. Although most of them were studie donly in animal experiments, this selective therapy for abnormally growing newly formed vessels is pathogenetically reasonable to treat PH and associated complications.

Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

Transjugular intrahepatic portosystemic shunt and splenectomy are more effective than endoscopic therapy for recurrent variceal bleeding in patients with idiopathic noncirrhotic portal hypertension

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS),splenectomy plus esophagogastric devascularization(SED)and endoscopic therapy+non-selectiveβ-blockers(ET+NSBB)are widely applied in secondary prevention of recurrent gastroesophageal variceal bleeding in patients with liver cirrhosis.These different treatments,however,have not been compared in patients with idiopathic noncirrhotic portal hypertension(INCPH).AIM To compare the outcomes of TIPS,SED and ET+NSBB in the control of variceal rebleeding in patients with INCPH.METHODS This retrospective study recruited patients from six centers across China.Demographic characteristics,baseline profiles and follow-up clinical outcomes were collected.Post-procedural clinical outcomes,including incidence of rebleeding,hepatic encephalopathy(HE),portal vein thrombosis(PVT)and mortality rates,were compared in the different groups.RESULTS In total,81 patients were recruited,with 28 receiving TIPS,26 SED,and 27 ET+NSBB.No significant differences in demographic and baseline characteristics were found among these three groups before the procedures.After treatment,blood ammonia was significantly higher in the TIPS group;hemoglobin level and platelet count were significantly higher in the SED group(P<0.01).Rebleeding rate was significantly higher in the ET+NSBB group(P<0.01).Mortality was 3.6%,3.8%and 14.8%in the TIPS,SED and ET+NSBB groups,respectively,with no significant differences(P=0.082).Logistic regression analysis showed that mortality was significantly correlated with rebleeding,HE,portal thrombosis and superior mesenteric vein thrombosis(P<0.05).CONCLUSION In patients with INCPH,TIPS and SED were more effective in controlling rebleeding than ET+NSBB,but survival rates were not significantly different among the three groups.Mortality was significantly correlated with rebleeding,HE and PVT.

Clinical Effects of the Qi-acupuncture Therapy of TCM on Portal Hypertension

Objective:To explore the effective prevention and treatment of portal hypertension(PH).Methods:A total of 220 patients who came to our hospital from March 2015 to October 2018 were treated.They were randomly divided into the treatment group and the control group,each with 110 cases.Before treatment,there was no significant differences in age,sex,clinical symptoms,signs,laboratory tests and color Doppler ultrasound related examinations between the 2 groups(P>0.05).Among them,the treatment group on the basis of traditional Chinese and Western medicine treatment in our hospital,the Qi-acupuncture therapy of TCM was added.The extra meridian acupoints along with acupoints were selected.The control group received conventional treatment with traditional Chinese and Western medicine in our hospital.Results:There were significant differences in clinical symptoms,signs and chemistry between groups after treatment(P<0.01).There were significant differences in test,color ultrasound related examination and so on(P<0.01).Those in the treatment group was significantly better than the control group(P<0.01).Conclusion:On the basis of the Qi-acupuncture therapy of TCM,selecting extra meridian acupoint and acupoints can effectively treat PH.

Drug Therapy Monitoring in Patients with Type 2 Diabetes and Hypertension

The aim of this paper is to detect, prevent and resolve DRP （drug-related problems） and NOM （negative outcomes associated with medication） in hospitalized patients with DM2 （type 2 diabetes） with HTN （hypertension） in a tertiary care clinic. Descriptive cross-sectional interventional study is used. DTM （drug therapy monitoring） was conducted in 73 patients using data obtained from clinical histories and interviews. NOM were detected based on symptoms and laboratory test results. The statistical significance was 0.05. It can be found that 23 DRP were detected, primarily in the category ＂likelihood of adverse effects＂ （30.43%） causing NOM in the ＂non-quantitative safety problem＂ category. The NOM detected were related to safety （62%）, effectiveness （24.5%） and necessity （13.5%）. Of the 68.57% of pharmacist interventions accepted, 48.57% were resolved and 20% were not resolved. A simple linear correlation （r = -0.34） analysis indicated a weak association between patient age and severity ofNOM. DTM made it＇possible to detect suspected DRP and NOM, which were then prevented or resolved, improving the control of HTN and DM2 and helping ensure better drug therapy outcomes for patients.

Clinical and experimental study of effect of Raondix Salviae Militiorrhiza and other blood activating and stasis eliminating Chinese herbs on hemodynamics of portal hypertension

AIM To study the effects of Radix Salviae Militiorrhiza (RSM), other blood-activating and stasis-eliminating Chinese herbs on hemodynamics of portal hypertension.METHODS Portal pressure of cirrhotic dogs after chronic common bile duct ligation was measured directly; portal blood flow in patients with liver cirrhosis were detected by ultrasound Doppler.RESULTS After administration of RSM and Radix Angelicae Sinensis (RAS) by intravenous infusion in cirrhosis dogs, the portal venous pressure (Ppv), wedge hepatic venous pressure (WHVP), hepatic venous pressure gradient (HVPG), were significantly decreased (P＜0.05-0.01), but the mean arterial pressure (MAP), and the heart rate (HR) remained unchanged. When nifedipine was used, Ppv, WHVP, MAP and HR were significantly decreased (P＜0.05), and the MVPG unchanged (P＞0.05). After administration of RSM, RSM+nifedipine and RSM+Hirudin+Nifedpin for 10-12 weeks, the diameter of portal vein (Dpv), spleen vein (Dsv), the portal venous flow (Qpv) and splenic venous flow (Qsv) in patients with hepatic cirrhosis were significantly lowered (P＜0.05-0.01), and the effect of RAS was weaker.CONCLUSIONS The efficacy of decreasing Ppv by Chinese herbs-RSM, RAS, etc. as compared with nifedipine, demonstrated that the Chinese herbs were slower in action than that of nifedipine, but more long-lasting and without side effects. Hence, long-term administration of Chinese herbs, would be more beneficial.

PPIs are not associated with a lower incidence of portal-hypertension-related bleeding in cirrhosis

AIM:To determine if proton pump inhibitor use in cirrhotic patients with endoscopic findings of portal hypertension is associated with a lower frequency of gastrointestinal bleeding.METHODS:Patients with cirrhosis and endoscopic findings related to portal hypertension,receiving or not receiving proton pump inhibitor (PPI) therapy,were included retrospectively.We assigned patients to two groups:group 1 patients underwent PPI therapy and group 2 patients did not undergo PPI therapy.RESULTS:One hundred and five patients with a median age of 58 (26-87) years were included,57 (54.3%) of which were women.Esophageal varices were found in 82 (78%) patients,portal hypertensive gastropathy in 72 (68.6%) patients,and gastric varices in 15 (14.3%) patients.PPI therapy was used in 45.5% of patients (n=48).Seventeen (16.1%) patients presented with upper gastrointestinal bleeding;in 14/17 (82.3%) patients,bleeding was secondary to esophageal varices,and in 3/17 patients bleeding was attributed to portal hypertensive gastropathy.Bleeding related to portal hypertension according to PPI therapy occurred in 18.7% (n=9) of group 1 and in 14% (n=8) of group 2 (odds ratio:0.83,95% confidence interval:0.5-1.3,P=0.51).CONCLUSION:Portal hypertension bleeding is not associated with PPI use.These findings do not support the prescription of PPIs in patients with chronic liver disease with no currently accepted indication.

Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization

AIM:To compare the incidence of early portal or splenic vein thrombosis(PSVT) in patients treated with irregular and regular anticoagulantion after splenectomy with gastroesophageal devascularization.METHODS:We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010.Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation,respectively.Group A(153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin(LMWH) irregularly.Group B(148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery,followed by oral warfarin and aspirin for one month regularly.The target prothrombin time/international normalized ratio(PT/INR) was 1.25-1.50.Platelet and PT/INR were monitored.Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.RESULTS:The patients' data were collected and analyzed retrospectively.Among the patients,94 developed early postoperative mural PSVT,including 63 patients in group A(63/153,41.17%) and 31 patients in group B(31/148,20.94%).There were 50(32.67%) patients in group A and 27(18.24%) in group B with mural PSVT in the main trunk of portal vein.After the administration of thrombolytic,anticoagulant and antiaggregation therapy,complete or partial thrombus dissolution achieved in 50(79.37%) in group A and 26(83.87%) in group B.CONCLUSION:Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization,and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy.Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.

Common parameters of acupuncture for the treatment of hypertension used in animal models

Hypertension is associated with at least 7.6 million annual deaths worldwide.While pharmacotherapy may provide good control for blood pressure,it sometimes induces adverse effects.Meanwhile,acupuncture has been used for the treatment of cardiovascular diseases,such as hypertension,coronary artery disease,and stroke,but its mechanisms of actions remain poorly understood.The efficacy of acupuncture depends on multiple constituent elements including acupoints,manipulation skills,and implementation programs,which are termed as acupuncture prescription.This review summarized the previous information of experimental use of acupuncture on animals including species,hypertension models,acupoints selection,acupoint location,stimulation protocols,and evaluation of effectiveness to provide useful guidance for researchers when performing acupuncture in animal experiments.

血管内皮生长因子及其受体抑制剂相关性高血压病理生理机制及临床诊疗的研究进展

肿瘤治疗相关心血管毒性(CTR-CVT)逐渐成为影响肿瘤幸存者预后的关键因素。以血管内皮生长因子(VEGF)为靶点研发的VEGF及其受体抑制剂(VEGFIs)作为新型抗肿瘤药物现已广泛应用于临床,可延长肿瘤患者的生存周期,改善患者预后,但VEGFIs诱导的高血压作为其最常见的CTR-CVT,可能会限制和影响其应用并引起严重心血管疾病(CVD)。对应用VEGFIs治疗的肿瘤患者应密切监测血压,早期评估,优化管理,使患者获得最佳的抗肿瘤疗效和最低的CTRCVT风险。现就VEGFIs相关性高血压的临床表现、发病机制、诊断和治疗策略进行综述,旨在为临床医生更好地管理和应对VEGFIs相关性高血压提供参考。

动脉粥样硬化性肾动脉狭窄高血压的研究进展

在心血管病临床实践中发现,肾动脉狭窄(renal artery stenosis,RAS)患者越来越多。RAS是引起高血压和(或)肾功能不全的重要原因,其主要病因是动脉粥样硬化。在我国,随着人口老龄化,在冠心病和外周血管疾病患者中动脉粥样硬化性肾动脉狭窄(atherosclerotic renal artery stenosis,ARAS)患者不断增多,而ARAS又是继发性高血压的重要病因之一。如果ARAS在临床上能够早期发现并得到纠正、诊治和有效干预,则对患者控制血压和提高生活质量有积极意义。本文从ARAS流行病学、ARAS与高血压的关系、ARAS诊断线索、检查方法及治疗等方面进行阐述。

TIPSS术使用组合支架与Viatorr支架治疗肝硬化并发门静脉高压症患者长期疗效比较

目的探讨经颈静脉肝内门体静脉分流术(TIPSS)中使用组合支架与Viatorr支架的长期疗效。方法2013年7月~2022年8月新疆医科大学第一附属医院介入治疗中心诊治的肝硬化并发门静脉高压症患者51例,均接受TIPSS术治疗,其中使用组合支架29例,使用Viatorr支架22例。术后随访5年。使用影像学检查肝内分流道通畅情况,应用Kaplan-Meler法分析比较两组分流道累积通畅率和生存率。结果使用Viatorr支架手术花费为73282.9(68190.6,81242.2)元,显著高于使用组合支架【61912.7(53713.6,67530.3)元,P<0.05】;第一年、二年、三年、四年和五年,Viatorr支架组肝内分流道累积通畅率分别为90.9%、77.3%、72.7%、71.4%和68.4%,组合支架组分别为86.7%、80.0%、76.7%、73.3%和70.0%,两组无统计学差异(P>0.05);Viatorr支架组累计生存率分别为95.5%、77.3%、72.7%、68.2%和59.1%,组合支架组分别为93.3%、86.7%、83.3%、83.3%和79.9%,两组无统计学差异(P>0.05)。结论本组资料显示,在行TIPSS手术时使用组合支架或Viatorr支架均可获得较好的临床效果,可根据供给情况选择使用。

2023美国心脏协会癌症治疗相关高血压科学声明解读

2023年1月,美国心脏协会(AHA)发布癌症治疗相关高血压科学声明,对其发病机制和临床管理进行综述。现代抗癌治疗多以心血管毒性为代价,其中高血压是最常见的副作用之一,尤其是血管内皮生长因子抑制剂、酪氨酸激酶抑制剂和蛋白酶体抑制剂。癌症治疗相关高血压通常是剂量限制性,并且在中断或停止治疗后通常是可逆的。高血压的确切分子机制尚不清楚,近期研究表明,一氧化氮减少、内皮素-1增加、氧化应激、内皮功能障碍、交感神经外流增加和微血管稀疏具有重要作用。结合国际心脏肿瘤学会(IC-OS)的建议,该文对癌症治疗相关高血压的诊断及管理进行解读,目前尚无针对癌症治疗相关高血压患者的降压药物循证证据,故遵循普通人群高血压指南,并且需要多学科合作优化管理,以确保癌症治疗的最佳治疗效果,同时最大限度地减少心血管毒性。

Effects of Chinese herbal medicine Yiqi Huaju Formula on hypertensive patients with metabolic syndrome:a randomized,placebo-controlled trial

BACKGROUND： Patients with hypertension coupled with metabolic syndrome （MetS） are among the high risk population in cardiovascular and cerebrovascular diseases. To reduce the prevalence of cardiovascular and cerebrovascular diseases, it is essential to appropriately control b^ood pressure together with other cardiovascular risk factors. OBJECTIVE： The current study was designed to investigate the therapeutic effects on blood pressure, blood pressure variability and other cardiovascular risk factors by giving Yiqi Huaju Formula, a compound traditional Chinese herbal medicine, in addition to routine treatment to hypertensive patients coupled with MetS. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： A total of 43 patients with hypertension coupled with MetS were recruited into this study. The enrolled patients were randomly divided into the Chinese herbal formula group （anti-hypertensive drugs plus Yiqi Huaju Formula, CHF） and the control group （anti-hypertensive drugs plus placebo）. The CHF group enrolled 22 patients while the control group received 21 cases. Treatments were given for 12 weeks in both groups. MAIN OUTCOME MEASURES： Parameters examined include 24-hour ambulatory blood pressure monitoring, body mass index, waist circumference, waist-to-hip ratio, homeostatic model assessment for insulin resistance （HOMA-IR）, fasting glycosylated hemoglobin （HbAlc）, fasting plasma glucose, 2-hour postprandial plasma glucose （PPG）, fasting plasma insulin, serum lipid, etc. RESULTS： Compared with the control group, the CHF group had significant improvement （P〈0.01） in anthropometric parameters, FPG, HOMA-IR, blood pressure amplitude, blood pressure variability and blood pressure load. CONCLUSION： This study showed that integrated traditional Chinese and Western medicine treatment can achieve better results in controlling blood pressure as well as other cardiovascular risk factors. The mechanism of controlling of blood pressure may be associated with the improvement of insulin sensitivity due to the Yiqi Huaju intervention. TRIAL REGISTRATION IDENTIFIER： ChiCTR-TRC-11001633.

基于组分合理性分析高血压复方药物

目的总结已上市的复方降压药并进行组分合理性分析,探讨其成分组成及疗效评估,为复方降压药的开发和创新提供参考。方法检索国内外相关文献,对已上市的复方药物及批准的药物联合治疗方案进行分析和归纳。结果复方降压药借助多种作用机制,显著改善药物依从性,降低心血管风险,并有效降低总体治疗成本。结论复方降压药在治疗高血压中具有独特的优势,是治疗高血压和伴随疾病的更优选择,这将为复方药物的开发提供新的创新动力。

肺动脉收缩压对妊娠合并分流性先天性心脏病相关肺动脉高压患者预后的影响

目的阐明肺动脉收缩压(SPAP)与妊娠合并分流性先天性心脏病相关肺动脉高压(PH)患者预后的关系。方法纳入2010年1月至2020年7月首都医科大学附属北京安贞医院254例妊娠合并分流性先天性心脏病相关PH患者的临床资料进行回顾性分析。按是否需要术后药物治疗分为未使用药物治疗组(131例)和药物治疗组(123例)。比较2组基本特征及围手术期管理资料。SPAP依据超声心动图估测,SPAP与术后药物治疗的相关性由回归模型评估并进行曲线拟合以及阈值饱和效应分析。结果药物治疗组体重指数和孕周均小于、术中输液量少于未使用药物治疗组,纽约心脏病协会心功能分级Ⅲ~Ⅳ级比例、SPAP水平、三尖瓣大量反流比例均高于未使用药物治疗组,差异均有统计学意义(均P<0.001)。在调整了可能的混杂因素后,SPAP与术后药物治疗存在非线性相关性,SPAP的转折点在90 mmHg(1 mmHg=0.133 kPa)。当SPAP≤90 mmHg时,术后药物治疗的风险随着SPAP的升高而增加(比值比=1.06,95%置信区间:1.02~1.09,P=0.001),SPAP>90 mmHg时,SPAP与术后药物治疗无显著相关性(比值比=0.99,95%置信区间:0.96~1.02,P=0.478)。相对于SPAP≤90 mmHg产妇,SPAP>90 mmHg者术后药物治疗的风险更高(比值比=3.06,95%置信区间:1.14~8.06,P=0.023)。结论合并重度PH产妇术后需要药物治疗风险高。对于轻中度患者,需要提高警惕,做好药物治疗准备及尽早改善肺动脉压力以降低妊娠风险。对于这些患者,多因素个体化评估更为重要。

肝移植术后严重门静脉狭窄的三维可视化成像与门静脉支架植入术疗效分析

目的分析肝移植术后严重门静脉狭窄的三维成像特征与优势,评估门静脉支架植入术效果。方法回顾性分析10例肝移植术后因严重门静脉狭窄接受门静脉支架植入的患者的临床资料,分析严重门静脉狭窄的影像学特征、三维重建的成像优势及介入治疗效果。结果10例患者中狭窄类型包括向心性缩窄3例,曲折成角致狭窄2例,受压狭窄2例,长段狭窄和(或)血管闭塞3例。三维重建图像在狭窄的准确判断、狭窄类型的辨别和狭窄累及长度判断方面具有优势。所有患者均成功接受门静脉支架植入术,支架植入后门静脉最狭窄处直径较治疗前增加[(6.2±0.9)mm比(2.6±1.7)mm,P<0.05],吻合口流速较治疗前下降[(57±19)cm/s比(128±27)cm/s,P<0.05],近肝处门静脉主干流速较治疗前增加[(41±6)cm/s比(18±6)cm/s,P<0.05]。1例患者因介入穿刺引起肝内血肿,经保守观察治疗后好转,其余患者均未出现相关并发症。结论三维可视化技术可以立体直观展示狭窄部位、特征与严重程度,有利于临床医师进行治疗决策和辅助介入操作。及时的门静脉支架植入术可以有效逆转病变进程并改善门静脉血流。