门静脉高压症 portal hypertension - 上海交通大学医学院精品 …

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1、门静脉高压症PortalHypertensionPortalhypertensionisapathologicstatethattheliverorassociatedstructuresobstructportalbloodflowandresultintheportalveinsystemhypertension,whichclinicallypresentsassplenomegalyandhypersplenism,hematemesisandmelenafromesophagealandgastricvaricesrupture

2、,andascites.门静脉高压症Whatisportalhypertension?★Anatomyofportalveinsystem★Etiology★Pathophysiology★Clinicalpresentation★Diagnosisanddifferentialdiagnosis★Treatment门静脉高压症门静脉系统解剖概要AnatomyofPortalVeinSystem门静脉高压症-解剖（1）了解内容◆Thebloodflowofsplenicveinis20-30%ofthatofportalvein门静脉高

3、压症-解剖（2）◆Theportalveinsystemisbetweentwocapillarynetworks◆Novalvesinportalveinsystemandthebloodflowcanbereversed◆Fourramuscommunicansbetweenportalandsystemiccirculations门静脉高压症-解剖（3）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→上腔静脉门静脉高压症-解剖（4）胃底、食道下段交通支2.肠系膜下静脉、直肠上静脉→直肠下端肛管交通支→直

4、肠下静脉肛管静脉→下腔静脉门静脉高压症-解剖（5）直肠下端肛管交通支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→下腔静脉门静脉高压症-解剖（6）前腹壁交通支4.肠系膜上、下静脉分支→腹膜后交通支→下腔静脉门静脉高压症-解剖（7）腹膜后交通支病因Etiology门静脉高压症-病因（1）了解内容Portalhypertensionshouldbedividedintothreetypesasitsbloodflowobstructedpositions:•pre-hepatictype:•intra-hepatictyp

5、e:•post-hepatictype:门静脉高压症-病因（2）•pre-hepatictype:theportalveintrunkitselfobstruction:■congenitaldeformityobliteration,stenosis■thrombosisinfection,trauma门静脉高压症-病因（3）•post-hepatictype:hepaticveinsorinferiorvenacavainhepaticlevelobstructionincludedcongenitaldeformityorthro

6、mbosis,calledBudd-Chiarisyndrome门静脉高压症-病因（4）巴德-吉亚利综合症•intra-hepatictype:95%,aclassificationispre-sinusoidalandpost-sinusoidalobstructionsbypathology门静脉高压症-病因（5）•pre-sinusoidalobstruction:ThemaincauseisschistosomialcirrhosisSchistosomialeggsdepositinsmallbrancheswithperi

7、pheralgranulation,resultinginobstructionofbloodflowandincreaseofportalveinpressure门静脉高压症-病因（6）血吸虫性•post-sinusoidalobstruction:Themaincauseispost-hepatitiscirrhosis(1)Fibroplasiaandregenerationofhepaticcellscompressthehepaticsinus,reducinginobstructedbloodflowandincreas

8、edportalveinpressure门静脉高压症-病因（7）(2)Theshuntsbetweenterminalhepaticarteriesandportalveinsopen,and