[医药卫生]门静脉高压症治疗.ppt

Surgical Complication of Cirrhosis and Portal Hypertension 第二军医大学东方肝胆外科医院 马优钢 [ Mechanism ] [ Some causes ] Toxins: alcohol Viruses: hepatitis B,hepatitis C Prolonged cholestasis: extrahepatic, intrahepatic Autoimmunity: lupoid hepatitis Metabolic disorders: hemochromatosis, Wilson’s disease alpha1-antitrypsin deficiency [Anatomy] [ Classification of portal hypertension ] Prehepatic portal hypertension Intrahepatic portal hypertension Posthepatic portal hypertension Prehepatic portal hypertension Intrahepatic portal hypentension Presinusoidal lever schistomiasis posthepatitis Sinusoidal lever alcoholic posthepatitis Postsinusoidal lever alcoholic, Budd-chiari’s syndrome Posthepatic portal hypertension Budd-Chiari’s syndrome: hepatic vein thrombosis, obstruction of vena cava Constrictive pericarditis Heart failure [ Pathophysiology of portal hypertension ] A portal pressure above the normal lever of 5 to 8 mmHg stimulates portosystemic collateraligation. Coronary vein Esophagogastric Short gastric vein varices [ Evaluation of the patient with cirrhosis ] Diagnosis of the underlying liver disease Estimations of functional hepatic reserve Identification of the site of upper GI hemorrhage, if present (esophageal varices, gastric varices, ectopic varices, portal hypertensive gastropathy) Definition of portal venous anatomy and hepatic hemadynamic evaluation [ Measurement of Hepatic Functional Reserve ] Child-Pugh Criteria for Hepatic Functional Reserve Measure A B C Serum bulirubin 2 2-3 3 ( mg per 100 ml ) Serum albumin 3.5 2.8-3.5 2.8 ( g per 100 ml ) Prothrombosis t