PDF(Pubmed)
Abstract：
Portal hypertension is defined by an increase in the portosystemic venous gradient. In most cases, increased resistance to portal blood flow is the initial cause of elevated portal pressure. More than 90% of cases of portal hypertension are estimated to be due to advanced chronic liver disease or cirrhosis. Transjugular intrahepatic portosystemic shunts, a non-pharmacological treatment for portal hypertension, involve the placement of a stent between the portal vein and the hepatic vein or inferior vena cava which helps bypass hepatic resistance. Portal hypertension may also be a result of extrahepatic portal vein thrombosis or compression. In these cases, percutaneous portal vein recanalisation restores portal trunk patency, thus preventing portal hypertension-related complications. Any portal blood flow impairment leads to progressive parenchymal atrophy and triggers hepatic regeneration in preserved areas. This provides the rationale for using portal vein embolisation to modulate hepatic volume in preparation for extended hepatic resection. The aim of this paper is to provide a comprehensive evidence-based review of the rationale for, and outcomes associated with, the main imaging-guided interventions targeting the portal vein, as well as to discuss the main controversies around such approaches.
摘要：
门静脉高压症的定义是门体静脉梯度的增加。在大多数情况下,门静脉血流阻力增加是门静脉压力升高的最初原因。据估计，超过90％的门静脉高压病例是由于晚期慢性肝病或肝硬化所致。经颈静脉肝内门体分流术，门脉高压症的非药物治疗，包括在门静脉和肝静脉或下腔静脉之间放置支架，这有助于旁路肝阻力。门静脉高压也可能是肝外门静脉血栓形成或压迫的结果。在这些情况下,经皮门静脉再通恢复门静脉主干通畅,从而预防门静脉高压相关并发症。任何门静脉血流受损都会导致进行性实质萎缩，并触发保存区域的肝再生。这提供了使用门静脉栓塞术调节肝体积以准备扩大肝切除的基本原理。本文的目的是对以下方面的理由进行全面的循证审查，以及与之相关的结果，以门静脉为目标的主要影像引导干预措施，以及讨论围绕这些方法的主要争议。
