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Fujian use the default font size: A New Method liver cirrhosis and portal hypertension 00:00 .0 Fujian marine fish: a new method of treatment of cirrhosis and portal hypertensi60 551 Dynamic Medical / enpproperty
Xinhua Fuzhou, Nov. 1 (Xinhua Yu fat) portal hypertension is a major common diseases caused by the cirrhosis. Fujian Provincial Hospital recently was a patient with cirrhosis and portal hypertension shunt combined with devascularization successful surgery for treatment, to liver cirrhosis and portal hypertension treatment have created an entirely new approach.
Responsible for implementing the operation, according to chief physician, said Yu Zhen-hui, portal hypertension is a common serious complication of esophageal and gastric varices, once broken, often resulting in fatal bleeding. Research data show that about two-thirds of patients with liver cirrhosis and eventually esophageal varices, of which about one third of the rupture will occur sooner or later, making surgical treatment of a problem.
Tour Zhenhui introduction, liver transplantation is the cure portal hypertension and effective method, but because of its high cost, rejection and other postoperative complications and a lack of donors, it is not yet universal. Conventional treatment of portal hypertension to use more breaking of pericardial blood vessel surgery, commonly known as devascularization, a few cases with splenic vein, renal vein shunt, commonly known as


the shunt. The two surgical methods have achieved some clinical effect, but their advantages and disadvantages. "Devascularization" method is simple, the exact bleeding, and can keep the blood supply of the liver. Stomach and spleen in the postoperative state of increased venous pressure and portal hypertension gastropathy occurred rebleeding rate. "Shunt" is in accordance with the "scatter" principle, the portal vein into the systemic circulation through the anastomosis channels, it can reduce the portal pressure to control bleeding. But the portal vein system has the stomach and spleen function of mesenteric zoning district, single-bypass surgery there is often head to the side branch, the pressure to reduce the effect of esophageal and gastric area is not ideal, and is likely to affect the liver portal vein perfusion, there is easy the shortcomings of hepatic encephalopathy.
Yu Zhenhui said the implementation of disconnection shunt combined with devascularization surgery absorbed, the advantages of shunt, can effectively control bleeding, and can decrease portal vein pressure, both to ease the portal hyperdynamic state, while maintaining perfusion to the liver to overcome the long-surgical treatment of these patients most of the world single devascularization caused by rebleeding rate and high incidence of portal hypertensive gastropathy ills.
- Health News 2004.09.23 Version 7
The eyes of the majority of patients, portal hypertension is indeed a rather abstract concept, which the body in front of the portal vein is a vein? High portal pressure is how it formed? When should treatment? Should be treated?Portal vein is the blood of the gastrointestinal tract into the liver, a vital channel for exchange, the liver is an essential nutrient structure, blood flow within the various nutrients contained in the negative to maintain normal liver function is an important condition. Cirrhosis, the liver vascular channels increased resistance, portal venous blood returning through the liver when blocked, this time, the body will be reflected through a series of mechanisms to significantly increased portal pressure, portal vein blood to ensure the "smooth" and nutrition into the liver. We can easily imagine, liver cirrhosis, if there is no corresponding increase in portal pressure, then the portal vein into the liver is significantly reduced, which is not conducive to the maintenance of liver function. Can be seen, when cirrhosis increased portal pressure is the body to maintain perfusion of liver sclerosis important compensatory mechanism for the maintenance of liver function is necessary.Cirrhosis, portal pressure increased as the body to maintain the stability of its essential function, but also harmful, it is a "double-edged sword."
In general, patients with chronic liver disease can be broadly divided into three stages: stage of chronic hepatitis, cirrhosis and portal hypertension phase. Three phases with each other, overlap, there is no clear boundary between.
In chronic liver disease stage, the disease is mainly sustained damage to liver cells and liver fibrosis caused by structural damage. At this point, the liver venous access has not changed obviously, no significant increase in portal pressure. In general, develop into liver cirrhosis from viral hepatitis requires a longer period of time, 10 to 30 years. From the clinical point of , the rate of hepatitis C cirrhosis compared with hepatitis B faster.
Continued development of liver inflammation, fibrosis and further increase on to the liver cirrhosis stage, this time, a significant hardening of the liver occurs, the liver's portal vein to become distorted and narrow, blood flow increased significantly by the resistance, portal venous pressure began to increase, and gradually increased. This stage in time the most difficult to define, depending on the length of time each of the stability of liver function differ.
When cirrhosis develops to a certain extent, then enter the portal hypertension phase. Portal pressure continues to rise, the inevitable happened esophagus - gastric varices, splenomegaly and hypersplenism. When the further development of the disease, primary peritonitis occurs, recurrent ascites or refractory ascites, many patients will emerge even recurrent esophageal - gastric variceal bleeding. With the gradual decline in liver function, patients with liver failure often occurs, or hepatic encephalopathy, or even liver cancer.
We can see that for a long time in patients with cirrhosis has been able to maintain liver function, portal pressure and a compensatory increase are inseparable. However, the continued increase in portal pressure, cirrhosis of the liver has become more complicated and critical condition late the direct cause.
Surgical treatment of portal hypertension mainly for the serious complications of cirrhosis rather than its own in the early and mid-term, even if there is portal hypertension, due to rarely cause bleeding esophageal varices, splenomegaly with hypersplenism, ascites, and other serious complications, medical treatment should be based, including the protection of liver cells, anti-virus, prevention and treatment of liver fibrosis. With the development of liver cirrhosis, portal hypertension persists, a serious complication of the above would have appeared. At this point, medical treatment alone is not enough to improve the condition and need surgical treatment or endoscopic therapy and other means.
The main objective of surgical treatment of portal hypertension is the prevention of serious complications, not the treatment itself. Surgical treatment of the most basic and most common surgical resection is the spleen breaking of pericardial blood vessel surgery. Splenectomy for hypersplenism effectively improve the situation, so that the peripheral blood platelet and white blood cell count rose to normal levels; breaking of pericardial blood can maximize prevention of esophageal surgery - variceal bleeding, so that patients rebleeding to minimize the possibility.
Of course, surgery on the stability or recovery of liver function also has a certain role, such as through the removal of the spleen, hypersplenism improved conditions, can effectively prevent the occurrence of primary peritonitis, which is the stability of liver function is good for prevent the development of cirrhosis of the liver is also a role. Through the prevention of upper gastrointestinal bleeding, also the maximum to avoid the bleeding and even liver damage caused by the body.
Visible, portal hypertension surgery to treat complications although the role is the emergence of a stable liver function but it also has a crucial role. Because, if not timely surgical treatment, patients often because of complications of portal hypertension in liver function and lose, or even catch a life.Clinically, patients with portal hypertension due to lack of the correct understanding of the pathophysiology, treatment of the tragedy are not uncommon. Many patients in the portal vein pressure is not too high, accept the shunt surgery, the portal vein pressure was significantly reduced, the portal vein on liver perfusion sharp decline, resulting in liver function rapidly deteriorated; there are some patients, although the portal vein pressure is high blood pressure does need some measures, but because of excessive portal pressure reduced, overkill, treatment counterproductive. Had a patient, male, 37 years old, because of cirrhosis and portal hypertension at a local hospital line splenorenal shunt, after 1 month that there is a clear hepatic coma, can lead to half a day to eat eggs, half consciousness, And the trend of more severe symptoms. March 2004 to hepatobiliary surgery treatment in our hospital, our patient's condition based on combined years of clinical experience in treatment of similar patients, that the rapid deterioration of liver function in patients with mainly related to inadequate shunt decisively to implement the operation for patients . Intraoperative findings in patients with portal pressure has been reduced to near normal levels, portal vein blood by a thick split-channel "steal" away the blood of the portal vein into the liver, almost zero, the liver because of the lack of adequate blood supply going to get small and hard. The diversion channel will be closed, the portal vein pressure increased to half the normal level, portal vein perfusion of the liver restored. Postoperative recovery was smooth, hepatic coma symptoms, liver function also improved significantly.
It is worth mentioning, like the above example not only for individual patients, but rather more common. These patients have such a common law because of cirrhosis and portal hypertension occurred in upper gastrointestinal bleeding and other complications, received shunt for treatment of different forms of liver function after 3 to 5 years showed a rapid deterioration of the trend, until a ascites, hepatic coma and other symptoms of liver dysfunction. The triage patients over 3 years after receiving a timely manner to correct, liver function decline under control, it is lucky.
Beijing Railway General Hospital, Chief Physician Sun Wenbing article entry: cross-flow sea Editor: lyw


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