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Abstract：
Portal hypertension from chronic liver disease leads to the formation of collateral blood vessels called spontaneous portosystemic shunts (SPSS). These shunts may form from existing vessels or through neo-angiogenesis. Their location affects clinical outcomes due to varying risks and complications. This review summarizes current knowledge on SPSS, covering their clinical impact and management strategies. Recent data suggest that SPSS increases the risk of variceal bleeding, regardless of shunt size. The size of the shunt is crucial in the rising incidence of hepatic encephalopathy (HE) linked to SPSS. It also increases the risk of portopulmonary hypertension and portal vein thrombosis. Detecting and assessing SPSS rely on computed tomography (CT) and magnetic resonance imaging. CT enables precise measurements and the prediction of cirrhosis progression. Management focuses on liver disease progression and SPSS-related complications, like HE, variceal bleeding, and portopulmonary hypertension. Interventional radiology techniques such as balloon-occluded, plug-assisted, and coil-assisted retrograde transvenous obliteration play a pivotal role. Surgical options are rare but are considered when other methods fail. Liver transplantation (LT) often resolves SPSS. Intraoperative SPSS ligation is still recommended in patients at high risk for developing HE or graft hypoperfusion.
摘要：
慢性肝病引起的门静脉高压导致侧支血管的形成，称为自发性门体分流（SPSS）。这些分流可以从现有血管或通过新血管生成形成。由于不同的风险和并发症，它们的位置会影响临床结果。这篇综述总结了目前关于SPSS的知识，涵盖其临床影响和管理策略。最近的数据表明，SPSS增加了静脉曲张破裂出血的风险，无论分流的大小。分流的大小对于与SPSS相关的肝性脑病（HE）的发病率上升至关重要。它还会增加门肺高压和门静脉血栓形成的风险。检测和评估SPSS依赖于计算机断层扫描（CT）和磁共振成像。CT能够精确测量和预测肝硬化进展。管理侧重于肝脏疾病进展和SPSS相关并发症，像他一样,静脉曲张出血,和门静脉高压症。介入放射学技术，如球囊闭塞，插头辅助，而弹簧圈辅助逆行静脉闭塞则起着举足轻重的作用。手术选择很少，但在其他方法失败时会考虑。肝移植（LT）通常解决SPSS。对于发生HE或移植物灌注不足的高风险患者，仍建议进行术中SPSS结扎。
