PORTAL-HYPERTENSION IN SCHISTOSOMIASIS - PATHOPHYSIOLOGY AND TREATMENT
PORTAL-HYPERTENSION IN SCHISTOSOMIASIS - PATHOPHYSIOLOGY AND TREATMENT
复制标题
DOI：
10.1590/s0074-02761992000800028
复制
发表时间：
1992-01-01
影响因子：
2.8
通讯作者：
DASILVA, LC
中科院分区：
文献类型：
--
作者：
DASILVA, LC
在严重感染的年轻患者中，有一个“非消化道”阶段的疾病与脾肿大，可以改善化疗后。在年轻患者中，肝脾型和蠕虫负荷之间的强相关性已被反复证明。肝内血管病变的模式似乎取决于两种机制：（a）卵栓塞，伴门静脉血管部分阻塞;（B）沿肝内门静脉系统出现小的门静脉侧支循环（沿着）。B型肝炎病毒（HBV）和丙型肝炎病毒感染在肝脏病变的发病机制中所起的作用是值得考虑的。选择性动脉造影显示肝动脉直径缩小，分支变细，呈弓形，勾勒出血管间隙。丰富的动脉网络，如尸检病例中所描述的，通常在体内看不到，除非在脾切除术或分流手术后。感染动物肝动脉血流增强。这些事实表明，选择性动脉造影显示的人类肝内动脉血管不良是由于动脉血向脾区的“功能性偏离”所致。治疗门静脉高压症的最佳结果是：食管胃血管离断术和脾切除术（EGDS），尽管再出血的风险仍然存在;经典的应放弃（近端）脾肾分流术（SRS）;远端脾肾分流术可能并发肝性脑病，尽管比SRS晚且比例较低。普萘洛尔目前正在研究中。在我科，食管静脉曲张出血的肥胖患者采用EGDS治疗，如果发生再出血，则采用静脉曲张硬化治疗。
In heavily infected young patients, there is a ''non-congestive'' phase of the disease with splenomegaly which can improve after chemotherapy. A strong correlation between hepatosplenic form and worm burden in young patients has been repeatedly shown. The pattern of vascular intrahepatic lesions, seems to depend on two mechanisms: (a) egg embolization, with a partial blocking of the portal vasculature; (b) the appearance of small portal collaterals along the intrahepatic portal sistem. The role played by hepatitis B virus (HBV) and C virus infections in the pathogenesis of liver lesions is variably considered. Selective arteriography shows a reduced diameter of hepatic artery with thin and arched branches outlining vascular gaps. A rich arterial network, as described in autopsy cases, is usually not seen in vivo, except after splenectomy or shunt surgery. An augmented hepatic arterial flow was demonstrated in infected animals. These facts suggest that the poor intrahepatic arterial vascularization demonstrated by selective arteriography in humans is due to a ''funtional deviation'' of arterial blood to the splenic territory.The best results obtained in treatment of portal hypertension were: esophagogastric devascularization and splenectomy (EGDS), although risk of rebleeding persists; classical (proximal) splenorenal shunt (SRS) should be abandoned; distal splenorenal shunt may complicate with hepatic encephalopaty, although later and in a lower percentage than in SRS. Propranolol is currently under investigation. In our Department, schistosomotic patients with esophagoal varices bleeding are treated by EGDS and, if rebleeding occurs, by sclerosis of the varices.