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

食管癌是肝硬化、特发性门静脉高压症、肝癌等门静脉高压症患者死亡的主要原因之一。食管切开加脾切除术是治疗食管静脉曲张的最佳方法，但不适用于肝功能储备差的患者。在这些患者中，经皮经肝封堵食管静脉曲张和内镜硬化治疗食管静脉曲张。为了更好地治疗食管静脉曲张，我们研究了肝硬化患者和特发性门静脉高压患者以及我们自制的门静脉高压犬的门静脉血流动力学。我们可以证明，与对照组（正常受试者和正常dofs）相比，肝硬化患者和特发性门静脉高压患者以及门静脉高压犬的门静脉流入（流入门静脉系统的血流量）显著增加。我们进一步评估了选择性内镜硬化治疗与选择性经皮经肝食管静脉曲张闭塞术在肝硬化和食管静脉曲张患者中的效果。我们可以证明，在预防非酒精性肝硬化患者复发性静脉曲张出血和死亡率方面，选择性经皮经肝食管顶点闭塞治疗优于选择性经皮经肝食管顶点闭塞治疗。

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.