附脐静脉开放对肝硬化食管静脉曲张发生及出血的影响：保护因素还是危险因素？

陈智鹏; 尹芳

doi:10.3969/j.issn.1001-5256.2022.04.036

附脐静脉开放对肝硬化食管静脉曲张发生及出血的影响：保护因素还是危险因素？

DOI: 10.3969/j.issn.1001-5256.2022.04.036

陈智鹏,
尹芳^, ,

空军军医大学西京医院消化内科，西安 710032

基金项目:

王宝恩肝纤维化研究基金项目 (20151028)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：陈智鹏负责搜集文献及撰写论文; 尹芳负责设计文献思路，批改文章并最后定稿。

详细信息

通信作者:
尹芳，yinfang_xj@163.com

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出版历程
- 收稿日期: 2021-08-13
- 出版日期: 2022-04-20

Influence of patent paraumbilical vein on the development of esophageal varices and esophageal variceal bleeding in liver cirrhosis: A protective factor or a risk factor?

Zhipeng CHEN,
Fang YIN^{,
,}

Department of Gastroenterology, Xijing Hospital, Air Force Medical University, Xi'an 710032, China

Research funding:

WBE Liver Fibrosis Foundation (20151028)

More Information

Corresponding author: YIN Fang, yinfang_xj@163.com (ORCID: 0000-0002-8165-879X)

摘要

摘要: 既往研究认为，肝硬化门静脉高压时附脐静脉开放能够减少门静脉血流，降低门静脉压力，减少食管静脉曲张及出血的发生，但临床上对此尚存争论。本文从门静脉侧支循环形成及附脐静脉特点、附脐静脉开放定义及诊断、附脐静脉开放对食管静脉曲张发生及出血的影响等3个方面回顾总结，认为附脐静脉开放并不能够减少食管静脉曲张及出血的发生。与既往观点相反，附脐静脉开放更应作为肝硬化门静脉高压进展的一个表现，易导致肝性脑病的发生，临床上应注意针对性预防。
- 肝硬化 /
- 高血压, 门静脉 /
- 食管和胃静脉曲张 /
- 脐静脉
Abstract: Previous studies believe that patent paraumbilical vein in cirrhotic portal hypertension can reduce portal venous flow, portal venous pressure, and the development of esophageal varices and esophageal variceal bleeding, but there are still controversies over this issue in clinical practice. This article reviews the formation of portal systemic collateral circulation, the characteristics of the paraumbilical vein, the definition and diagnosis of patent paraumbilical vein, and the influence of patent paraumbilical vein on the development of esophageal varices and esophageal variceal bleeding, and it is believed that patent paraumbilical vein may not reduce the development of esophageal varices and esophageal variceal bleeding. Contrary to the previous points of view, patent paraumbilical vein should be regarded as a manifestation of the progression of cirrhotic portal hypertension, which can lead to the complications such as hepatic encephalopathy, and therefore, targeted prevention measures should be adopted in clinical practice.
- Liver Cirrhosis /
- Hypertension, Portal /
- Esophageal and Gastric Varices /
- Umbilical Veins

HTML全文

图 1 门静脉侧支循环示意图

注：PV，门静脉; LGV，胃左静脉; GEV，食管胃静脉曲张; SV，脾静脉; IMV，肠系膜下静脉; SMV，肠系膜上静脉; PUV，附脐静脉; Vena cava，下腔静脉; HV，肝静脉; LRV，左肾静脉; GRS，胃肾分流; SRS，脾肾分流; TIPS，经颈静脉肝内门体分流; Caput Medusae，海蛇头体征; RV，直肠静脉曲张。

Figure 1. Collateral pathways in portal hypertension

下载: 全尺寸图片幻灯片

图 2 B超诊断附脐静脉开放示意图

注：肝圆韧带内有离肝血流通过。

Figure 2. Sonograms of patent paraumbilical vein

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图 3 CT诊断附脐静脉开放示意图

注：横断面可见肝圆韧带内血管走行(白色箭头所指)。

Figure 3. Computerized tomography of patent paraumbilical vein(white arrow)

下载: 全尺寸图片幻灯片

图 4 附脐静脉走行示意图

注：a，传统附脐静脉走行; b，血流动力学变化引起的非传统附脐静脉走行，附脐静脉发出的肝内分支血流方向由进入肝实质变为反向，附脐静脉血流方向则无变化; c~d，解剖结构变化引起的非传统附脐静脉走行，可检测到1或多条离肝血流经肝实质走行后与肝外附脐静脉相连。

Figure 4. Different pathways of patent paraumbilical vein

下载: 全尺寸图片幻灯片

表 1 不同研究中附脐静脉开放组Child-Pugh分级情况

Table 1. Child-Pugh classification of the patent paraumbilical vein group in different studies

年份	作者	样本量(例)	附脐静脉开放组 Child-Pugh A/B/C比例
1989	Mostbeck等^[29]	11
1992	Morin等^[33]	55	34.5%¹⁾/65.5%
1994	Caturelli等^[14]	20	45%/40%/15%
1995	Sacerdoti等^[34]	184	26.5%/29.6%/56.8%
2000	Gupta等^[31]	50
2009	Zardi等^[21]	326	24.7%/66.7%/8.6%
2012	邝乃乐等^[35]	738	21%/54.9%/24.1%
2014	Kondo等^[23]	181	27.6%/53.2%/19.2%
2017	Calame等^[32]	172
注：1)包括Child-Pugh A、B级。

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