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Portal hypertension therapeutic use of portal hypertension basic knowledge of portal hypertension symptoms of portal hypertension prevention and health care portal hypertension medication principles and secondary inspection . drug Principle 1. The average patient using basic drugs, blood tran
sfusions, and protect the liver support treatment. 2. Seriously ill patients, cirrhosis of the liver complications or infection based on how it treated? Anti-infection treatment should be based on clinical manifestations and laboratory changes, and generally recommended for 3 weeks. As for selective intestinal decontamination treatment, studies have shown that preventive doses of non-intestinal absorption of gentamicin, neomycin can reduce the infection rate. The head of portal hypertension after treatment 1. Placed drainage tube in patients with drainage tube patency should be maintained, and to observe the drainage situation, until no bloody fluid extraction, the drainage tube should be removed as soon as possible. 2. Application of liver drug, disable all the drugs damage the liver. 3. And postoperative supportive care, such as continuing to add white patients with portal hypertension in points 1. Intraoperative fluid should enter the total control of crystal, crystal with a 3:1 ratio of colloid is appropriate; colloid in whole blood and fresh plasma and hydroxyethyl starch-based. 2. The choice of surgical incision surgical approach should be based on the patient”s body and the surgeon”s learning portal hypertension before surgery for preoperative preparation: multi-portal hypertension caused by the cirrhosis, liver decompensation have a direct relationship to the operation the success or failure, it must be for adequate preoperative preparation to reduce postoperative complications and ensure the success of treatment. 1. To improve the general condition, the liver decompensation, and doors Surgical treatment of portal hypertensi. Indications: a history of esophageal variceal bleeding or bleeding in patients with crisis; cases of acute bleeding, the non-surgical treatment is still can not control the bleeding; splenomegaly and hypersplenism with obvious impact on the quality of life of patients. 2. Operative conditions: elective surgery patients, a treatment for portal hypertension principles 1. Esophageal or gastric variceal bleeding in non-surgical treatment, only accompanied by jaundice, massive ascites, patients with severely impaired liver function. Specific measures include: lose new blood, fluid blood volume expansion; drugs to stop bleeding; drugs reduce portal venous pressure of 8 articles 7 articles / page Go to page
Portal hypertension (general surgery) is due to different reasons in different parts of the portal vein obstruction occurs, resulting in blood stasis, portal pressure increased, to cause splenomegaly and secondary hypersplenism, esophageal and gastric submucosal varices and bleeding, and ascites and a series of symptoms. It is not a single disease, all obstacles can cause portal vein lesions, can lead to portal hypertension, therefore, patients with portal hypertension is often manifested in clinical hypertension and out performance of the primary disease. In China, resulting in portal hypertension is mainly due to cirrhosis. In most parts of the Yangtze River, mostly for schistosomiasis endemic areas, schistosomiasis is mainly caused by liver cirrhosis; in other areas are mainly post-hepatitis cirrhosis. Currently, hepatitis caused by cirrhosis and portal hypertension rates have risen, has become the surgical clinical problems to be solved. The extrahepatic portal vein obstruction. Congenital malformations such as the portal vein, portal vein thrombosis and other, less common. Surgical treatment of portal hypertension is the purpose of treatment or prevention of gastric, esophageal variceal bleeding, hypersplenism and refractory ascites. Surgical method of treatment more effective is better, but there are still some complications and mortality. Poor efficacy or invalid, and postoperative complications, liver damage and more serious because the patients, therefore, according to the different etiology and pathogenesis of the different order to develop and select a condition for effective treatment is the key to treatment .
1. Splenomegaly and hypersplenism; 2. Hematemesis or blood in the stool; 3. Ascites; 4. May have hepatomegaly, some patients have jaundice, abdominal varicose veins, spider and other clinical manifestations of liver cirrhosis;
Diagnosis based on:
1. Have viral hepatitis, schistosomiasis, a history of alcoholism; 2. The main symptoms and signs; 3. Barium swallow X-ray examination or endoscopy, can be found in esophageal and gastric varices; 4. Ultrasound examination can suggest cirrhosis, splenomegaly, ascites, and portal vein and splenic vein diameter enlargement; 5. blood when hypersplenism check all blood cells are reduced to the most obvious platelets and white blood cells; 6. Liver function tests can be found in varying degrees damage, such as ALT, AST, AKP increased, decreased serum albumin, albumin and globulin ratio upside down, blood bilirubin, prolonged prothrombin time and so on.
1. Esophageal or gastric variceal bleeding in non-surgical treatment, only accompanied by jaundice, massive ascites, patients with severely impaired liver function. Specific measures include: lose new blood, fluid blood volume expansion; drugs to stop bleeding; drugs decrease portal vein pressure; third balloon catheter to stop bleeding; by endoscopic sclerotherapy; percutaneous transhepatic coronary vein embolization; transjugular hepatic portal vein shunt; and Liver treatment. 2. Esophageal or gastric variceal bleeding in the surgical treatment for no jaundice, no obvious ascites patients. Surgical resection with spleen Qi devascularization doors, shunt surgery. 3. The treatment of hypersplenism with the use of splenectomy or splenic artery embolization. 4. The treatment of refractory ascites, can be a variety of shunt surgery, abdominal – venous bypass and thoracic duct – the left jugular vein anastomosis.
Prevention of common sense:
As portal hypertension is a major cause of cirrhosis, surgical treatment of portal hypertension of various methods are the basic cause of cirrhosis can not be removed only for cause cirrhosis and portal hypertension caused by esophageal and gastric the end of variceal bleeding, hypersplenism and refractory ascites were treated, only "temporary." The treatment of cirrhosis, that is, "root", mainly medical treatment, its efficacy is currently minimal. Therefore, the prevention of the occurrence of cirrhosis, ie to prevent schistosomiasis and hepatitis virus infections, prevention is the key to portal hypertension. Surgical treatment of portal hypertension should be aware that its efficacy depends largely on the situation of the patient decompensated liver function, liver function was improved, effective operation; the other hand, poor liver function, surgical results after both short and long term poor, and more complications, therefore, should be based on the status of liver function to guide the choice of treatment or surgery, as well predict the treatment effects. Especially for acute bleeding patients, as far as possible through effective non-surgical treatment to control the bleeding first, and then actively Liver treatment with short-term (one month) to the liver function improved to good condition, and then elective surgery, which is to improve surgical treatment of these patients is very important.
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