门静脉高压症上消化道出血不同指南诊治共识外科部分的比较分析

doi:10.3969/j.issn.1005-6483.2019.01.018

摘要/Abstract

摘要： 目的门静脉高压症不同诊治指南外科手术部分论述有许多不同，比较其中的差异并分析原因。方法通过检索找出7篇公认度高的指南：Baveno Ⅵ共识、美国肝病协会指导（AASLD）、英国指南（UK）、奥地利指南（Austrain）、巴西共识（Brazil）、我国肝病指南和我国外科指南。精读筛选出外科手术部分论述，追溯参与制订专家及相关参考文献进行对比分析。另外对Baveno不同版本共识进行对比分析。结果不同指南中参与外科专业人员：AASLD、奥地利、巴西、我国肝病指南各1名；参考外科文献比例：Baveno Ⅵ、美国、奥地利、巴西、我国肝病指南及我国外科指南分别为0、1.4%、5.7%、3.2%、6.1%、6.7%、25.0%。Baveno出血共识中外科部分论述，第Ⅰ、Ⅱ版提及分流、断流术是内镜治疗失败后合适的手段，第Ⅲ、Ⅳ、Ⅴ版为仅推荐分流术，第Ⅵ版非肝外血管病变部分外科内容消失。结论药物、内镜、TIPS的快速发展、参与指南制订的外科专家较少，忽略引用外科手术相关的文献，是权威指南缺失外科声音的原因。英国指南具有一定程度的包容性和客观性。医生是指南最终的决策者。

关键词: 门静脉高压症, 指南诊治共识, 外科手术, 参考文献, 比较分析

Abstract: Objective There are many differences in the surgical contents of guidelines or consensuses for upper gastrointestinal bleeding in patients with portal hypertension.Comparing and analyzing the causes can promote understanding and recognizing.Methods Seven high-profile guidelines were selected by searching：Baveno Ⅵ consensus，AASLD guidance，UK guideline，Austrian consensus，Brazil consensus，Chinese guideline from Liver Diseases/Digestive Disease/Endoscopy Branch of Medical Association（abbr.Chinese hepatopathy guideline）and Chinese surgery guidelines from Portal Hypertension Group of Surgery Branch，Medical Association（abbr.Chinese surgery guideline）.Surgery parts in contents were selected to analyze by comparing the participants and tracing the relevant references after intensive reading the documents.Besides，different editions of Baveno consensus were compared and analyzed.Results In different guidelines：AASLD，Austrian，Brazil and Chinese hepatopathy guideline enrolled 1 surgery professionals respectively；The ratio of referenced surgery articles in Baveno VI，AASLD，Austrian，Brazil，Chinese hepatopathy guideline and Chinese surgery guideline，is 0，1.4%、5.7%、3.2%、6.1%、6.7%、25.0%，respectively.The surgery parts of the Baveno consensus，showed that shunts and devascularizations are the appropriate means when endoscopic therapy failed on hemostatic treatment in Ⅰ，Ⅱ edition，only shunts are recommended in Ⅲ，Ⅳ，Ⅴ edition，and none surgery approaches recommended except extrahepatic vessel disease in Ⅵ edition.Conclusion The rapid progress of drugs，the advanced skills of endoscopy and Transjugular intrahepatic portosystemic shunt（ abbr.TIPS），the lack of surgery professionals involved，and the lack of citing surgery articles，were one of the reasons for lacking voices of surgery in leading guidelines.The UK Guideline is relatively comprehensive and objective.Doctors is the final decisionmaker on the application to practice of guidelines and consensuses.

Key words: portal hypertension, guidelines and consensus, surgry, references, comparison and analysis

齐瑞兆, 史宪杰, 李志伟, 赵新, 王胜智, 刘庆艳, 郑扬, 张鹰, 朱晓雅, 常伟华, 常正尧, 张昆, 胡兴龙, 吴敏良. 门静脉高压症上消化道出血不同指南诊治共识外科部分的比较分析[J]. 临床外科杂志, 2019, 27(1): 62-66.

QI Ruizhao, SHI Xianjie, LI Zhiwei, et al.. Comparison and analysis of surgery parts in different guidelines of upper gastrointestinal bleeding with portal hypertension[J]. JOURNAL OF CLINICAL SURGERY, 2019, 27(1): 62-66.

参考文献

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