摘要
目的调查研究门静脉高压症外科治疗现状以了解我国当前外科治疗的真实情况及未来发展。方法本研究由中国肝胆胰专科联盟、中国门静脉高压联盟(CHESS)联合发起,调查对象为2021年国内开展门静脉高压症外科治疗的378家医疗机构及其团队,全面调查2021年国内开展门静脉高压症外科治疗的医院及其团队开展门静脉高压症外科手术的基本情况,包括手术例数、手术方式、术后并发症的处理、首要作用、存在的困惑和阻碍,肝移植以及内镜和经颈静脉肝内门腔静脉分流术(transjugular intrahepatic portosystemic shunt,TIPS)开展的情况等。结果经调查,2021年全国378家医疗机构共计开展8512例门静脉高压症外科手术,以脾切除术联合断流术为主(53.0%),腹腔镜手术占比76.1%,预防再出血(67.0%)是首要作用,72.8%的团队外科术后常规应用预防性抗凝药物,80.7%的团队认为术后门静脉血栓的形成是开展手术的主要难点,内镜治疗和介入TIPS治疗均已熟练开展的医疗机构达到65.3%,门静脉高压症患者未行肝移植治疗的原因以医院无肝移植的资质(69.3%)和患者经济因素(69.0%)为主。结论本次调研充分显示外科治疗是我国门静脉高压症治疗的重要组成部分,未来仍需进一步规范化手术适应证的把握、手术操作的流程以及术后并发症的处理,需进一步开展更多高质量的前瞻性、多中心临床随机对照研究。
Objective To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods This study is jointly sponsored by China Hepatobiliary&Pancreatic Specialist Alliance&Portal Hypertension Alliance in China(CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension,including case load,surgical approaches,management of postoperative complications,primary effects,existing confusion and obstacles,liver transplantation(LT),laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS),etc.Results A total of 8512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%)and 72.8%of hospitals used preventive anticoagulants after conventional surgery.And 80.7%of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3%of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions Surgery is an integral part of management of portal hypertension in China.However,it is imperative to further standardize the grasp of surgical indications,the handling of surgical operation and the management of postoperative complications.Moreover,prospective,multi-center randomized controlled clinical studies should be performed.
作者
郑磊
李海洋
王继洲
梁霄
窦剑
王继涛
樊强
丁雄
翟文龙
晋云
李波
何松青
李涛
刘军
王葵
李志伟
曾永毅
邵英梅
卜阳
尚东
麻勇
娄诚
尹新民
贺杰峰
朱海宏
武金才
徐志丹
巴桑顿珠
鲁建国
张立婷
赵建国
吕凌
吕国悦
蔡念
张丹图
罗蒙
张万广
祁小龙
陈孝平
Zheng Lei;Li Haiyang;Wang Jizhou;Liang Xiao;Dou Jian;Wang Jitao;Fan Qiang;Ding Xiong;Zhai Wenlong;Jin Yun;Li Bo;He Songqing;Li Tao;Liu Jun;Wang Kui;Li Zhiwei;Zeng Yongyi;Shao Yingmei;Bu Yang;Shang Dong;Ma Yong;Lou Cheng;Yin Xinmin;He Jiefeng;Zhu Haihong;Wu Jincai;Xu Zhidan;Basang Dunzhu;Lu Jianguo;Zhang Liting;Zhao Jianguo;Lyu Ling;Lyu Guoyue;Choi Nim;Cheung Tan To;Luo Meng;Zhang Wanguang;Qi Xiaolong;Chen Xiaoping(Department of General Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Hepatobiliary Surgery,The Hospital Affiliated to Guizhou Medical University,Guiyang 550001,China;Department of Hepatobiliary Surgery,The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230036,China;Department of General Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Hepatobiliary Surgery,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Hepatobiliary Surgery,Xingtai People's Hospital Affiliated to Hebei Medical University,Xingtai 054001,China;Department of Hepatobiliary Surgery,The Second Affiliated Hospital,Chongqing Medical University,Chongqing 400010,China;Department of Hepatobiliary and Pancreatic Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Hepatobiliary Surgery,The First Hospital of Yunnan Province,Kunming 650032,China;Department of Hepatobiliary Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Hepatobiliary Surgery,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of General Surgery,Emergency General Hospital,Beijing 100028,China;Department of Liver Transplantation and Hepatobiliary Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Hepatic SurgeryⅡ,Shanghai Eastern Hepatobiliary Surgery Hospital,Shanghai 200438,China;Hepato-Biliary Surgery Division,Shenzhen Third People's Hospital,The Second Affiliated Hospital,Southern University of Science and Technology,Shenzhen 518112,China;Department of Hepatobiliary Surgery,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Hepatobiliary and Echinococcosis Surgery,Digestive and Vascular Surgery Center,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Hepatobiliary Surgery,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of General Surgery,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Department of Minimal Invasive Hepatic Surgery,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Hepatobiliary Surgery,Third Central Hospital of Tianjin,Tianjin 300170,China;Department of Minimally Invasive Surgery,The People's Hospital of Hunan province,Changsha 410000,China;Department of Hepatobiliary Surgery,Shanxi Bethune Hospital,Third Hospital of Shanxi Medical University,Taiyuan 030032,China;Department of Hepatobiliary Surgery,Qinghai Provincial People's Hospital,Xining 810000,China;Department of Hepatobiliary Surgery,Hainan Provincial People's Hospital,Hainan Medical College,Haikou 570031,China;Department of Organ Transplant Center,The People's Hospital of Jiangxi province,Nanchang 330006,China;Department of General Surgery,People's Hospital of Tibet Autonomous Region,Lhasa 850000,China;Department of General Surgery,The Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,China;Department of Infection,the First Hospital of Lanzhou University,Lanzhou 730000,China;Department of Hepatobiliary,Pancreatic and Spleen Surgery,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China;Hepatobiliary Center,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Hepatobiliary Pancreatic Surgery,Liver Transplantation Center of Jilin University,the First Hospital of Jilin University,Changchun 130021,China;General Surgery department of Centro Hospitalar Conde de S.Januario,Macao 999078,China;Division of Hepatobiliary and Pancreatic and Liver Transplant Surgery,The University of Hong Kong Queen Mary Hospital,Hong Kong 999077,China;Hepatic Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Center of Portal Hypertension,Department of Radiology,Zhongda Hospital,Medical School,Southeast University,Nanjing 210009,China)
出处
《中华器官移植杂志》
CAS
2023年第3期152-159,共8页
Chinese Journal of Organ Transplantation
基金
国家自然科学基金(82100639)。
关键词
肝移植
门静脉高压症
问卷调查研究
Liver transplantation
Portal Hypertension
Survey research