门静脉高压症（张伟）临床-外科学课件-上海交通大学附属瑞金医院.pptVIP

门静脉高压症Portal Hypertension Portal hypertension is a pathologic state that the liver or associated structures obstruct portal blood flow and result in the portal vein system hypertension, which clinically presents as splenomegaly and hypersplenism, hematemesis and melena from esophageal and gastric varices rupture, and ascites.  ★ Anatomy of portal vein system ★ Etiology ★ Pathophysiology ★ Clinical presentation ★ Diagnosis and differential diagnosis  ★ Treatment 门静脉系统解剖概要Anatomy of Portal Vein System ◆ The blood flow of splenic vein is  20-30% of that of portal vein ◆ Four ramus communicans between portal and systemic circulations 1.胃冠状静脉、胃短静脉→胃底、食道下段交 通支→奇静脉、半奇静脉→上腔静脉 2.肠系膜下静脉、直肠上静脉→ 直肠下端肛管交通支 →直肠下静脉 肛管静脉→下腔静脉 3.脐旁静脉→ 前腹壁交通支 →腹上深静脉→ 上腔静脉、 腹下深静脉→下腔静脉 4.肠系膜上、下静脉分支→ 腹膜后交通支→  下腔静脉 病 因Etiology Portal hypertension should be divided into three types as its blood flow obstructed positions:  ? pre-hepatic type:  ? intra-hepatic type: ? post-hepatic type: ? pre-hepatic type: the portal vein trunk itself obstruction:■congenital deformity obliteration, stenosis■thrombosis infection, trauma ? post-hepatic type:  hepatic veins or inferior vena cava in hepatic level obstruction included congenital deformity or thrombosis, called Budd-Chiari syndrome  ? intra-hepatic type: 95%, a classification is pre-sinusoidal and post-sinusoidal obstructions by pathology ? pre-sinusoidal obstruction: The main cause is schistosomial cirrhosisSchistosomial eggs deposit in small branches withperipheral granulation, resulting in obstructionof blood flow and increaseof portal vein pressure ? post-sinusoidal obstruction:The main cause is post-hepatitis cirrhosis(1)Fibroplasia and regeneration of hepatic cells compress the hepatic sinus, reducing in obstructed blood flow and increased portal vein pressure (2)The shunts between terminal hepatic arteries and port