门脉高压症[文字可编辑].ppt

Thanks! Dr. Zhijun He Thanks! Dr. Zhijun He Thanks! Dr. Zhijun He Thanks! Dr. Zhijun He Thanks! Dr. Zhijun He Thanks! Dr. Zhijun He Thanks! Dr. Zhijun He Thanks! Dr. Zhijun He Thanks! Dr. Zhijun He Thanks! Dr. Zhijun He Thanks! Dr. Zhijun He 硬化剂注射 endoscopic esophageal variceal sclerotherapy 食道静脉曲张破裂出血的手术治疗 Surgical treatment ? 分流术 shunt operation 断流术 devascularization operation ? 经颈静脉肝内门腔支架分流术 Transjugular intrahepatic portosystemic stent shunt, TIPS 门腔分流术 portocaval shunt operation 部分门腔分流术 partial portacaval shunt operation 肠腔分流术 mesocaval operation 选择性远端脾肾静脉分流术 Warren operation 断流术 devascularization operation 内镜及药物处理失败后的食道静脉曲张破裂出血的 手术处理方案 2. 脾亢的外科治疗 脾切除术 或 脾切除 + 断流术 3. 腹水的外科治疗 ? 腹腔静脉转流术 ? TIPS 肝移植 ? 4. 终末期肝病的根治性处理方案 --liver transplantation 手术步骤 ? 器官修整 ? 病肝切除 ? 供肝植入 切除的病肝 良好的肝移植效果 肝癌和胆汁淤积性肝硬化患者 原发性胆汁淤积症患者肝移植术后 其它各类疾病患者肝移植术后状态 再次肝移植 我中心开展的腹部联合器官移植 肝肾联合移植 （省内首位成功病例） 胰肾联合移植 （省内首例） 肝胰联合移植 （省内首例，国内第二例） 第二节 肝前型门脉高压症 Prehepatic portal hypertension 病因 etiology ? 先天畸形 congenital malformation ? 脐静脉炎 omphalophlebitis ? 门静脉海绵样变 cavernous transformation of portal vein ? 动静脉瘘 A-V fistula 肝前型门脉高压症 Prehepatic portal hypertension ? 临床表现 clinical manifestation ? 处理 treatment 第三节 肝后型门脉高压症 Budd-Chiari Syndrome ? The Budd-Chiari syndrome is caused by hepatic venous obstruction. The obstruction may occur at the level of the inferior vena cava , the hepatic veins , or the central veins within the liver itself. 病因 Etiology ? ? ? ? congenital webs (most common in Africa and Asia), acute/chronic thrombosis (most common in the West): hypercoagulable states associated with polycythemia vera, myeloproliferative disorders, paroxysmal nocturnal hemoglobinuria, and defects in the coagulation cascade, as in conditions associated with high estrogen levels (e.g., pregnancy and administration of birth control pills) . malignancy . obliterative endophlebitis of the intrahepatic veins 分型 Typing ? I 型： 57% 下腔静脉隔 膜 II 型： 38% 下腔静脉弥 漫性狭窄或阻塞 III 型： 5% 肝静脉阻塞 ? ? 症状 Symptoms Acute