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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

引用本文:
Citation:

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
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

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?

Research funding: 

WBE Liver Fibrosis Foundation (20151028)

More Information
  • 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。

     

  • 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

    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

    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)

    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

    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。
    下载: 导出CSV
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