Pathophysiology of Portal Hypertension
Pathophysiology of Portal Hypertension
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DOI：
10.1007/978-3-642-37078-6_144
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发表时间：
2015-01-23
期刊：
影响因子：
--
通讯作者：
Jiménez W
中科院分区：
文献类型：
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作者：
Morales-Ruiz M;Rodríguez-Vita J;Ribera J;Jiménez W
我们目前对肝门脉系统生理学的认识主要归功于十六、十七世纪三位血管研究先驱的工作：A. Vesalius，W. Harvey和F.格里森Vesalius被认为是现代人体解剖学的创始人，在他有影响力的著作De humani corporis fabrica libri septem中，他详细阐述了肝门静脉系统的第一个解剖图谱（Vesalius 2013）。威廉·哈维爵士（Sir William Harvey）在他的《Animalibus》（Harvey 1931）中建立了血液循环的本质，奠定了现代心血管研究的基础。最后，F. Glisson描述了胃肠道-肝血管系统（Child 1955）。这些生理描述后来补充了临床观察。在18世纪和19世纪，Morgagni、Puckelt、Cruveillem和Osler首先将常见的肝脏并发症（腹水、脾肿大和胃肠道出血）与门静脉系统阻塞联系起来（Sandblom 1993）。这些是吉尔伯特、维拉雷特和汤普森在20世纪初建立门静脉高压早期定义的基础。在此期间，Thompson首次通过剖腹手术对部分患者进行了门静脉压力的直接测量（吉尔伯特和Villaret，1906; Thompson等，1937）。考虑到所有这些里程碑，并转述艾萨克·牛顿爵士的话，如果肝病学家看得更远，那就是站在巨人的肩膀上。近年来，随着门静脉高压症基础研究和临床研究的不断深入，人们对门静脉高压症发病机制的认识也有了很大的提高。然而，这一领域是不断变化的，肝病学家正在不断确定新的病理机制，并为这种临床疾病开发新的治疗策略。因此，本章的目的是总结目前的知识，这种临床条件。
The bases of our current knowledge on the physiology of the hepatic portal system are largely owed to the work of three pioneering vascular researchers from the sixteenth and the seventeenth centuries: A. Vesalius, W. Harvey, and F. Glisson. Vesalius is referred to as the founder of modern human anatomy, and in his influential book, De humani corporis fabrica libri septem, he elaborated the first anatomical atlas of the hepatic portal venous system (Vesalius 2013). Sir William Harvey laid the foundations of modern cardiovascular research with his Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (Harvey 1931) in which he established the nature of blood circulation. Finally, F. Glisson characterized the gastrointestinal-hepatic vascular system (Child 1955). These physiological descriptions were later complemented with clinical observations. In the eighteenth and nineteenth centuries, Morgagni, Puckelt, Cruveilhier, and Osler were the first to make the connection between common hepatic complications – ascites, splenomegaly, and gastrointestinal bleeding – and obstruction of the portal system (Sandblom 1993). These were the foundations that allowed Gilbert, Villaret, and Thompson to establish an early definition of portal hypertension at the beginning of the twentieth century. In this period, Thompson performed the first direct measurement of portal pressure by laparotomy in some patients (Gilbert and Villaret 1906; Thompson et al. 1937). Considering all these milestones, and paraphrasing Sir Isaac Newton, if hepatologists have seen further, it is by standing on the shoulders of giants. Nowadays, our understanding of the pathogenesis of portal hypertension has largely improved thanks to the progress in preclinical and clinical research. However, this field is ever-changing and hepatologists are continually identifying novel pathological mechanisms and developing new therapeutic strategies for this clinical condition. Hence, the aim of this chapter is to summarize the current knowledge about this clinical condition.