Research progress in diagnosis and treatment of portal hypertension and its complications

doi:10.3877/cma.j.issn.2095-3232.2026.04.006

Abstract

Abstract:

Portal hypertension (PH) refers to a type of comprehensive disease with abnormally elevated pressure in the portal vein system, which is primarily caused by liver diseases (such as liver cirrhosis) or blockage of portal vein blood flow, leading to collateral circulation and serious, even life-threatening complications. The management of PH has evolved from a single treatment modality to multidisciplinary comprehensive treatment. Multiple diagnosis and treatment approaches are integrated to reduce portal hypertension, thus lowering the mortality caused by venous bleeding, achieving effective treatment of PH and obtaining complementary advantages. In this article, research progress in the diagnosis and treatment of PH and its complications was illustrated.

Key words: Portal hypertension, Diagnosis, Treatment, Complication

Yu Zhang, Weihua Zheng, Junjing Zhang. Research progress in diagnosis and treatment of portal hypertension and its complications[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(04): 537-544.

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References 62

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项目	优点	缺点	临床应用
实验室检查	初步诊断和评估病情	缺乏特异性，不能直接反映门静脉压力，干扰因素多，难以评估侧枝循环情况	广泛
HVPG检测	PH诊断金标准	要求高，操作复杂，费用高，有创性，存在风险和并发症	较少
肝活检	直观、准确判断肝脏病变类型和程度	侵入性检查，存在风险和并发症	视病情而定
经皮肝穿刺门静脉造影	直观观察门静脉系统的血管狭窄、阻塞、扭曲以及侧枝循环形成情况	属于有创性检查，易引起辐射暴露，对技术要求高，不能全面评估肝脏功能，存在风险和并发症	以病情而定
血清学标志物	便捷、成本低、可重复性好	单一指标诊断效率低、易受混杂因素干扰，难以对CSPH作出诊断或排除诊断；联合多个血清学指标难以兼顾诊断灵敏度和特异度	仍在探索阶段^[17]
多普勒超声^[18]	肝脏大小、形态回声异常	受操作人员技术水平影响较大	广泛
TE	操作简便，成本效益好，是设备缺乏地区PH、食管胃静脉曲张严重程度诊断和评估的手段^[19]		广泛
声脉冲辐射力弹性成像	操作简便、无创，可评估肝纤维化及PH的严重程度^[20]	易受组织炎症、肥胖等因素干扰，早期病变灵敏度有限	有潜力
CT	高质量清晰全面的门静脉系统血管图像，直观显示病变	缺乏统一质控标准，可纳入研究的病例数远低于血清学标志物研究	广泛
MRI	准确显示门静脉系统的病理改变，能在复杂环境下识别门静脉直径及横断面；		广泛
内镜	直观，诊断准确，指导治疗	观察范围有限，结果受主观因素影响大，有创性	基层医院普及
EV	潜在诊断以及治疗手段		临床前试验阶段
ctDNA	潜在诊断以及治疗手段		临床前试验阶段

项目	优点	缺点	临床应用
实验室检查	初步诊断和评估病情	缺乏特异性，不能直接反映门静脉压力，干扰因素多，难以评估侧枝循环情况	广泛
HVPG检测	PH诊断金标准	要求高，操作复杂，费用高，有创性，存在风险和并发症	较少
肝活检	直观、准确判断肝脏病变类型和程度	侵入性检查，存在风险和并发症	视病情而定
经皮肝穿刺门静脉造影	直观观察门静脉系统的血管狭窄、阻塞、扭曲以及侧枝循环形成情况	属于有创性检查，易引起辐射暴露，对技术要求高，不能全面评估肝脏功能，存在风险和并发症	以病情而定
血清学标志物	便捷、成本低、可重复性好	单一指标诊断效率低、易受混杂因素干扰，难以对CSPH作出诊断或排除诊断；联合多个血清学指标难以兼顾诊断灵敏度和特异度	仍在探索阶段^[17]
多普勒超声^[18]	肝脏大小、形态回声异常	受操作人员技术水平影响较大	广泛
TE	操作简便，成本效益好，是设备缺乏地区PH、食管胃静脉曲张严重程度诊断和评估的手段^[19]		广泛
声脉冲辐射力弹性成像	操作简便、无创，可评估肝纤维化及PH的严重程度^[20]	易受组织炎症、肥胖等因素干扰，早期病变灵敏度有限	有潜力
CT	高质量清晰全面的门静脉系统血管图像，直观显示病变	缺乏统一质控标准，可纳入研究的病例数远低于血清学标志物研究	广泛
MRI	准确显示门静脉系统的病理改变，能在复杂环境下识别门静脉直径及横断面；		广泛
内镜	直观，诊断准确，指导治疗	观察范围有限，结果受主观因素影响大，有创性	基层医院普及
EV	潜在诊断以及治疗手段		临床前试验阶段
ctDNA	潜在诊断以及治疗手段		临床前试验阶段

治疗方案	优点	缺点	临床应用
药物治疗
中药治疗	不良反应小，个体化治疗	作用机制复杂，用药周期长，起效慢	少
NSBB	预防出血效果好，长期应用方便，价格低廉	有局限性，存在禁忌证，不良反应较多，个体差异大，不能控制急性出血；	广泛
血管活性药物	止血效果迅速，适用范围广，联合内镜治疗效果好	长期使用受限，有严重不良反应，价格相对较高	广泛
介入治疗(TIPS、BRTO、PTVE、PSE)	快速有效降低门脉压力，安全、创伤小、恢复快，改善长期预后，联合治疗潜力大	术后并发症风险高，技术要求高，费用昂贵	广泛
内镜治疗
EVL	操作简单，创伤小，恢复快，止血效果好，并发症少	易复发，对胃底静脉曲张效果差，存在脱落风险	广泛
EIS	疗效确切，适用范围广，可重复治疗	并发症较多，操作要求高，患者舒适度差
EVL与EIS结合	减少并发症，降低再出血率和提高根除率
手术治疗
分流术	治疗效果明显，对肝脏功能影响较小	术后HE发病率高，肝功能衰竭的风险大	广泛
断流术	止血效果确切，对肝脏血流影响小，手术操作相对简单	术后再出血率较高，易导致胃黏膜病变
分流联合断流术	降低HE的发病率和再出血率，降低门静脉压力	费用高、手术范围广，手术创伤大，手术难度高
肝移植	解决PH最为彻底的方法	供肝严重缺乏、费用高昂	受限
内镜联合药物治疗	止血成功率高，安全、有效		广泛

治疗方案	优点	缺点	临床应用
药物治疗
中药治疗	不良反应小，个体化治疗	作用机制复杂，用药周期长，起效慢	少
NSBB	预防出血效果好，长期应用方便，价格低廉	有局限性，存在禁忌证，不良反应较多，个体差异大，不能控制急性出血；	广泛
血管活性药物	止血效果迅速，适用范围广，联合内镜治疗效果好	长期使用受限，有严重不良反应，价格相对较高	广泛
介入治疗(TIPS、BRTO、PTVE、PSE)	快速有效降低门脉压力，安全、创伤小、恢复快，改善长期预后，联合治疗潜力大	术后并发症风险高，技术要求高，费用昂贵	广泛
内镜治疗
EVL	操作简单，创伤小，恢复快，止血效果好，并发症少	易复发，对胃底静脉曲张效果差，存在脱落风险	广泛
EIS	疗效确切，适用范围广，可重复治疗	并发症较多，操作要求高，患者舒适度差
EVL与EIS结合	减少并发症，降低再出血率和提高根除率
手术治疗
分流术	治疗效果明显，对肝脏功能影响较小	术后HE发病率高，肝功能衰竭的风险大	广泛
断流术	止血效果确切，对肝脏血流影响小，手术操作相对简单	术后再出血率较高，易导致胃黏膜病变
分流联合断流术	降低HE的发病率和再出血率，降低门静脉压力	费用高、手术范围广，手术创伤大，手术难度高
肝移植	解决PH最为彻底的方法	供肝严重缺乏、费用高昂	受限
内镜联合药物治疗	止血成功率高，安全、有效		广泛

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