胆石症合并肝硬化门静脉高压症的微创治疗

我院1988年～2002年开展了先期内镜保胆取石术(Endoscopic Minimally Invasive Cholecystolithotomy，EMIC)治疗胆石症合并肝硬化门静脉高压症(Cholelithiasis Accompanied with Cirrhosis，CAC)病人42例，取得了满意的疗效。现报告如下：     

肝硬化门静脉高压治疗的哲学思考

从哲学的角度看，肝硬化门静脉高压从发病机制到临床实践蕴涵着对立统一规律。充分认识这些规律，并自觉地运用于临床实践中不仅对青年医师有所助益，同时对此类患者的临床干预将产生积极的影响。     

肝硬化门静脉高压致肺动脉高压症一例诊治体会

1临床资料某男,56岁,职员。患慢性乙型肝炎肝硬化7年,因门静脉高压并腹水、黄疸、肝功能异常在当地多次住院,保肝降酶退黄对症治疗,未抗病毒治疗,2004年脾切除。2008年初始感胸闷、憋气、心悸、头晕,活动后喘息、下肢浮肿。2008年6月来我院就诊。既往大量饮酒史20年。父母兄弟姐妹及配偶均无乙肝史。否认输血史。     

预防性断流术治疗肝硬化门静脉高压症的疗效观察

【目的】探讨预防性断流术治疗肝硬化门静脉高压症的临床疗效。【方法】102例肝功能良好的肝硬化门静脉高压症患者,合并食管胃底静脉重度曲张,行预防性断流术65例,药物治疗37例,比较两种方法的临床疗效。【结果】预防性断流组患者无一例死亡,术后腹腔内出血2例,左膈下包裹性积液1例,均行保守治疗后治愈,术后无肝功能衰竭及肝性脑病发生,脾功能亢进消失,随访18个月无上消化道出血病例;药物治疗组随访18个月出现上消化道大出血12例,其中并发肝性脑病2例,死亡2例,脾功能亢进无改善。与药物组相比,手术组食管胃底曲张静脉消失率显著增高,上消化道出血率明显降低,其差异均有统计学意义（P〈0．01）。【结论】对于肝硬化门静脉高压症患者,合理把握手术指征,行预防性断流术,疗效满意,值得临床推广应用。     

原位辅助性部分肝移植治疗门静脉高压症的实验研究

目的 在原位辅助性部分肝移植(APOLT)动物模型基础上，观察其对猪肝硬化门静脉高压症的初步治疗效果。方法 采用结扎胆总管的方法复制猪胆汁性肝硬化动物模型，6只健康良种幼猪作为供体组，6只肝硬化模型猪为受体组，肝移植采用APOLT术。术中观察血流动力学和生化指标；术前、术后当天及7d观察门静脉压力、血胆红素及肝功能，同时用彩色多普勒超声检查门静脉最大流速及流量。结果 胆总管结扎8周后见肝脏假小叶形成，小叶周围结缔组织增生明显，有胆栓及胆泥沉积，证实胆汁性肝硬化模型成功。6只猪APOLT术后5只存活。术后7d动物活杀病理检查见移植肝形态、色泽正常，各吻合口无扭曲、漏血和血栓形成；移植肝部分肝小叶结构紊乱，肝细胞萎缩或消失，肝小叶内大量淋巴细胞和浆细胞浸润，中央静脉周围肝小叶细胞浊肿，可见淋巴细胞浸润；受体肝无明显变性及坏死。术后7d存活猪经彩色多普勒超声检察发现，移植肝门静脉血流比宿主肝门静脉血流增多，回流通畅，移植肝功能良好。血总胆红素、丙氨酸转氨酶及天冬氨酸转氨酶等肝功能指标明显好转，术后7d门静脉压力与术前相比显著降低。结论 APOLT术对门静脉高压症有一定的治疗作用，是一种较有希望的治疗肝硬化门静脉高压的新方法。     

门静脉高压症的最终选择——肝移植

门静脉高压(portal hypertension,PHT)是终末期肝病的必然结果.约半教以上的肝病患者甚至在肝功能尚处于代偿期时PHT已经存在,而且伴随着肝硬化的进展,PHT的风险度迅速增加,甚至超过原发疾病而成为患者的主要致死原因.     

门静脉高压症的外科治疗

在我国 ,门静脉高压症的主要病因是病毒性肝炎所导致的肝硬化 ,而其外科治疗主要是针对解决食管胃底曲张静脉的破裂出血 ,其次是纠正脾大和脾功能亢进。主要的手术方法有门体静脉分流术和门奇静脉断流术 ,以及目前蓬勃发展的肝移植术。1　门体分流术门体分流术是通过门静脉与体静脉吻合而分流血液 ,以降低门静脉压力 ,进而达到制止食管和胃底曲张静脉出血的目的。早在 190 3年Ｅｃｋ在狗的身上成功实行端侧门腔静脉分流术 ,随后Ｖｉｄａｌ在人体实行 ,但直到 1930年门腔分流术才被引入治疗肝硬化 ,Ｗｈｉｐｐｌｅ和Ｂｌａｃｋｍｏｒ同时介绍…     

肝硬化门静脉高压症联合断流术17例分析

我院2001／2004年择期采用贲门周围血管离断、脾切除、联合食管下段横断术治疗食管胃底静脉曲张破裂出血17例，疗效满意。报告如下。     

改良Sugiura手术治疗门静脉高压症的探讨

目的探讨改良Sugiura手术治疗门静脉高压症的疗效。方法对16例肝炎后肝硬化门静脉高压症行改良Sugiura手术患者的临床资料回顾分析。结果随访2月～2年本组患者近期止血效果确切，无肝性脑病发生，肝功能、血常规明显好转，无吻合口漏发生。结论改良Sugiura手术是治疗门静脉高压症的一种合理可取的术式，其疗效满意，操作方便，经济实用，适合基层医院开展。     

肝硬化门静脉高压症手术的护理体会

目的探讨肝硬化门静脉高压症的围术期护理。方法回顾分析我院自2004—2009年收治的肝硬化门静脉高压症手术患者45例的临床资料。结果合并轻度黄疸6例,少量腹水15例,肝硬化43例,急诊手术19例,3例因病情危重未做手术自动出院,其余均行手术治疗,住院天数6—48d,治愈36例,好转6例,未愈3例。结论通过围术期护理,及时采取有效的预防和治疗措施,以提高手术疗效。     

肝移植4例报告

目的 总结肝移植的临床经验.方法 对4例男性患者施行肝移植,其中2例为经典式原位肝移植,另2例为背驮式原位肝移植,行肝移植的原因分别1例为肝炎后肝硬化、3例为肝炎后肝硬化合并原发性肝癌.术后免疫抑制剂采用甲基强的松龙、他克莫司及吗替麦考酚酯(骁悉),同时采用抗乙肝免疫球蛋白(抗-HBsAg)及拉米夫定预防乙肝病毒复发.结果 4例均获治愈,已分别存活16个月、13个月、11个月和10个月.结论 肝移植是治疗终末期肝病的最有效的治疗方法.适应证选择和手术时机的正确把握,围术期的严密监测、正确处理是保证肝移植患者存活的关键.     

门静脉营养对肝硬化、门静脉高压的影响

目的 探讨门静脉营养在治疗肝硬化、门脉高压症中的作用。方法 将80例入组患者随机分为两组,对照组40,仅予以常规周围静脉肝营养液输入;研究组40,于术后第1d给予肝营养液门静脉内缓慢输入。两组于术后1、2、4w分别检查血清谷丙转氨酶、胆红素及白蛋白,研究组于术中、术后检测自由门静脉压(FPP)。结果 术后1、2、4w血清谷丙转氨酶、血清胆红素下降速度及血清白蛋白升高速度均较对照组快,4w末肝功复常率两组比较差异存在显著性(P<0.05)。研究组术后早期FPP升高,术后随着肝功恢复及侧支循环的建立,FPP逐渐回落。结论 门静脉营养在肝硬化、门脉高压症治疗中,能短时间内较快恢复肝功。肝营养液门静脉内缓慢输入法具有疗效可靠,操作安全等特点。     

肝硬变患者胆囊结石的腹腔镜治疗

目的 探讨腹腔镜治疗肝硬变患者胆囊结石的可行性。方法 回顾分析1997年10月～2003年12月该科采用腹腔镜治疗47例合并肝硬变的胆囊结石的临床资料。结果 42例成功LC，3例中转开腹胆囊切除术，2例开腹胆囊切除术加T管引流。全组病人均痊愈出院。结论 只要注意适应证，腹腔镜是治疗合并肝硬变胆囊结石的良好选择。     

多层螺旋CT门静脉造影诊断肝硬化门静脉高压

目的评价门静脉CT血管造影对肝硬化门脉高压患者的诊断价值.方法对43例经临床、肝功能和影像学检查诊断的肝硬化门脉高压患者进行门静脉CT血管成像(CTPV),对门静脉主干、主要属支和侧支循环血管进行显示和测量.结果 43例患者均成功地实施了门静脉CTPV,门静脉主干显示率100%,胃左静脉97.6%,胃短静脉44.2%,食管胃底静脉曲张90.7%,脾/胃肾分流28.7%,脐静脉、腹壁静脉曲张分别为46.5%、44.4%.其中门静脉主干宽度为(13.94±2.47) mm,胃左静脉主干宽度为(5.62±2.40) mm.结论 CTPV可显示肝硬化门脉高压患者的门-体静脉之间侧支循环血管,有助于对门脉高压合并消化道出血患者选择合理治疗方案及进行疗效随访.     

彩超检测胃左静脉参数预测肝硬化胃底出血的价值

目的通过彩色多普勒测定胃左静脉内径、血流速度、血流量、血流方向等指标，探讨其预测食管静脉曲张出血风险的价值。方法肝硬化门静脉高压症86例，均接受彩色多普勒、电子胃镜及肝炎标志物、肝功能等检查，评价标准：随访24个月内经内镜检查确定为食道胃底静脉曲张破裂出血对比分析出血组与非出血组的胃左静脉血流动力学特点。结果胃左静脉呈离肝血流的患者中发生食管静脉破裂出血者多于向肝血流患者，差异有显著性意义（P〈0．01）；随着肝功能损害加重，胃左静脉内径呈增宽趋势，Child B、C级肝功能患者中，出血与非出血组间比较差异有显著性意义（P〈0．05）；在不同Child级别中，出血与非出血组患者在肝动脉血流峰速度（Vmax）、Q上无显著差异。结论彩色多普勒测定胃左静脉血流方向、内径能预测食管静脉曲张出血。     

Clinico-pathogenetic and pharmacotherapeutic aspects of portal hypertension in liver cirrhosis

The paper is concerned with the pathogenetic mechanisms of the main manifestations of portal hypertension in liver cirrhosis. The current approaches to pharmacotherapy of hemorrhages from the varicose veins of the esophagus and potential prevention of repeated hemorrhages are evaluated. Different variants of diuretic therapy for ascites are discussed.     

Systemic lupus erythematosus complicated by noncirrhotic portal hypertension: A case report and review of literature

A 48 year-old Chinese woman suffering from polyarthritis, irregular fever and trichomadesis was admitted to the hospital. A diagnosis of systemic lupus erythematosus (SLE) was made based on polyarthritis, pancytopenia, reduced complement 3, multiple positive autoantibodies, a positive Coomb’s test and protein in her urine. In addition, splenomegaly was detected during physical examination and confirmed by abdominal ultrasonography and magnetic resonance imaging, indicating that the patient had SLE and portal hypertension. Further negative investigations ruled out the possibility of cirrhosis. The patient was diagnosed with active SLE complicated by noncirrhotic portal hypertension (NCPH) without liver histopathology, due to the patient’s refusal for liver biopsy. Portal vein diameter and splenomegaly decreased following treatment with methylprednisolone, hydroxychloroquine and metoprolol tartrate. To date, SLE complicated by NCPH has rarely been reported, as it is under-recognized clinically as well as pathologically. Here we describe a case of SLE complicated by NCPH and review the literature for its characteristics, which may contribute to improving the recognition of NCPH and reducing missed and delayed diagnosis of this disorder.     

Drug therapy of pulmonary and portal hypertension in liver cirrhosis

Detailed examination of hemodynamics in patients with portal and pulmonary hypertension was performed upon acute drug tests and course administration of nitrosorbide++, corinfar and propranolol. Ultrasound and rheography investigations were employed to elucidate the relations between portal and pulmonary hypertension in cirrhosis patients. Criteria of early diagnosis are discussed. Nitrosorbide++ produced positive effect on hepatic blood flow, corinfar improved pulmonary hemodynamics in lack of its influence on hepatic blood flow, while propranolol resulted in the drop of both portal and pulmonary hypertension, normalization of general hemodynamics.     

Hepatitis B virus-related liver cirrhosis complicated with dermatomyositis: A case report

BACKGROUND Twenty percent of patients infected with hepatitis B virus(HBV)develop extrahepatic manifestations with HBV detected in the lymph nodes,spleen,bone marrow,kidneys,and skin.HBV infection has been associated with some autoimmune disorders.Dermatomyositis(DM)is an idiopathic inflammatory myopathy,which involves a viral infection,and DM has been identified in patients infected with HBV,but there is no direct histological evidence for an association between HBV and DM.CASE SUMMARY We describe a familial HBV-infected patient admitted with liver function abnormality,rashes,a movement disorder,and an elevated level of creatine kinase(CK).A computed tomography scan of the lung showed pulmonary fibrosis,and a liver biopsy identified nodular cirrhosis.An electromyogram revealed myogenic damage,and a muscle biopsy showed nuclear migration in local sarcolemma and infiltration of chronic inflammatory cells.Immunohistochemical staining showed negative results for HBsAg and HBcAg.Fluorescence in situ hybridization showed a negative result for HBV DNA.The patient was diagnosed with HBV-related liver cirrhosis complicated with DM and was treated with methylprednisolone,mycophenolate mofetil,and lamivudine.Eight months later,the patient was readmitted for anorexia and fatigue.The blood examination showed elevated levels of aminotransferases and HBV DNA,however,the CK level was within the normal range.The patient developed a virological breakthrough and lamivudine was replaced with tenofovir.CONCLUSION DM in chronic HBV-infected patients does not always associate with HBV.Antiviral and immunosuppressive drugs should be taken into consideration.