Development of therapy for esophageal varices:medical splenectomy and formation of intrahepatic shunt

食道静脉曲张是肝硬变、特发性门脉高压症、肝细胞癌等门脉高压症患者的主要死亡原因之一。食道横断加脾切除是治疗食道静脉曲张的最好方法，但不适用于肝功能不全的患者。在这些患者中，已经进行了经皮经肝门静脉闭塞术和内镜下食道静脉曲张硬化治疗。为了更好地治疗食道静脉曲张，本研究对肝硬化和特发性门脉高压症患者的门静脉血流动力学进行了研究。在我们制作的门脉高压犬中，我们可以证明，在肝硬变患者、特发性门静脉高压症患者以及门脉高压犬中，门静脉血流量(流入门静脉系统的血流量)与他们的对照组(正常人和正常门脉高压犬)相比显著增加。我们进一步评估了选择性内窥镜硬化治疗与选择性经皮经肝门静脉曲张闭塞术在预防非胆汁性肝硬变患者复发性静脉曲张出血和死亡率方面的效果。

Esophageal verices is one of major causes of death in patients with portal hypertension such as liver cirrhosis, idiopathic portal hypertension,hepatocellular carcinoma stc.An operation consisting of esophageal transection and splenectomy is the best treatment for esophageal varices but it cannot be applied to patients with poor hepatic functional reserve.In these patients percutaneous transhepatic obliteration of esophageal varices and endoscopic sclerotherapy of esophageal verices have been performed.In this study,to develop a better medical treatment for esophageal varices,we studied portal hemodynamics in patients with liver cirrhosis and those with idiopathic portal hypertension, and in portal hypertensive dogs which we made.We could demonstrate that portal venous inflow (blood flow into the portal vein system)was significantly increased in patients with liver cirrhosis and those with idiopathic portal hypertension as well as in portal hyertensive dogs compared with their controls(normal subjects and nomal dofs).We further evaluated the effects of elective endoscopic sclerotherapy in comparison with elective percutaneous transhepatic obliteration of esophageal varices in patients with liver cirrhosis and esophageal varices.We could demonstrate that elective endoscopic intravariceal sclerotherapy is superior to elective percutaneoous transhepatic obliteration of esophageal verices in the prevention of recurrent variceal hemorrhage and mortality in nonalcholic cirrhosis.