门静脉高压症概述AnatomyoftheLiverAnatomyofportalvein门静脉解剖概要门V系与腔V系之间4组交通支1.胃底、食管下段交通支2.前腹壁交通支3.直肠下端、肛管交通支4.腹膜后交通支分型CAUSE分型肝炎后肝硬变：肝窦、窦后血虫病性肝硬变：窦前门静脉压力门脉高压的病理变化脾肿大、脾功能亢进交通支扩张胃底食管下段交通支出血病理腹水HEMODYNAMICCHANGESCLINICALPRESENTATIONINVESTIGATION临床表现脾肿大、脾功能亢进呕血或黑便腹水等临床表现诊断辅助检查INVESTIGATIONINVESTIGATIONINVESTIGATIONnormalliver大出血时的鉴别诊断治疗治疗TREATMENTSTRTEGIES食管胃底静脉出血的治疗非手术治疗抗休克治疗生长抑素垂体加压素三腔管压迫止血三腔管用法放置三腔管后三腔管并发症、注意事项纤维内镜硬化剂注射、圈套经颈内静脉肝内门体分流术TIPS手术治疗肝功能评级，Child分级Child-Pugh手术与Child分级分流手术DECOMPRESSIONTRANSJUGULARINTRAHEPATICPORTOSYSTEMICSHUNT（TIPS，TIPSS）PORTOSYSTEMICSHUNTSPARTIALPORTOSYSTEMICSHUNTSSELECTIVEVARICEALDECOMPRESSION断流手术DEVASCULARIZATIONPROCEDURES两种术式比较分流术的特点断流术的特点脾切除：脾肿大、脾亢顽固性腹水肝移植术INDICATIONFORLIVERTRANSPLANTATIONEnd-stageliverdiseaseRecipient（受体手术）移除病肝NewliverProductionofbilebynewliverSchematicofcompletedlivertransplantationGraftImplantationBudd－Chiari综合征临床表现与诊断治疗?MANAGEMENTOFVARICEALBLEEDING4.腹膜后交通支血虫病性肝硬变：窦前辅助检查治疗食管胃底静脉出血的治疗放置三腔管后两种术式比较Recipient（受体手术）