门静脉高压症治疗ppt课件.ppt

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1、SurgicalComplicationofCirrhosisandPortalHypertension第二军医大学东方肝胆外科医院马优钢[Mechanism]SomecausesHepatocellularinjuryNecrosisfibrosisnodularregenerationcirrhosisalteredhepaticarchitectureperisinusoidalfibrosisIncreasedhepaticvasecularresistanceportalhypertension[Somecauses]Toxins:alcoholViruses:hepatitis

2、B,hepatitisCProlongedcholestasis:extrahepatic,intrahepaticAutoimmunity:lupoidhepatitisMetabolicdisorders:hemochromatosis,Wilson’sdiseasealpha1-antitrypsindeficiency[Anatomy][Classificationofportalhypertension]PrehepaticportalhypertensionIntrahepaticportalhypertensionPosthepaticportalhypertensionPr

3、ehepaticportalhypertensionIsolatedsplenicveinthrombosisLeftsidedportalhypertensionPancreaticinflammationorneoplasmThemostcommoncauseisportalveinthrombosis.(Halfinchildren)IntrahepaticportalhypentensionPresinusoidalleverschistomiasisposthepatitisSinusoidalleveralcoholicposthepatitisPostsinusoidalle

4、veralcoholic,Budd-chiari’ssyndromerarePosthepaticportalhypertensionBudd-Chiari’ssyndrome:hepaticveinthrombosis,obstructionofvenacavaConstrictivepericarditisHeartfailure[Pathophysiologyofportalhypertension]Aportalpressureabovethenormalleverof5to8mmHgstimulatesportosystemiccollateraligation.Coronary

5、veinEsophagogastricShortgastricveinvaricesAzygosvein[Evaluationofthepatientwithcirrhosis]DiagnosisoftheunderlyingliverdiseaseEstimationsoffunctionalhepaticreserveIdentificationofthesiteofupperGIhemorrhage,ifpresent(esophagealvarices,gastricvarices,ectopicvarices,portalhypertensivegastropathy)Defin

6、itionofportalvenousanatomyandhepatichemadynamicevaluation[MeasurementofHepaticFunctionalReserve]Child-PughCriteriaforHepaticFunctionalReserveMeasureABCSerumbulirubin<22-3>3(mgper100ml)Serumalbumin>3.52.8-3.5<2.8(gper100ml)Prothrombosistime1-34-6>6AscitesNoneSlightModerateNeurologicdisorderNoneMini

7、malAdvanced,”coma”[OtherLaboratoryTests]Anemia(bleeding,nutritionaldeficiency,hemolysis,orbonemarrowdepressing)LeukopeniaThromhocytopeniaProthrombintimeAlpha-fetoproteinleverLiverbiopsy(causeofcirrhosis,activityo