基于计算流体力学仿真的肝硬化食管胃底静脉曲张破裂出血风险评估研究

Risk Assessment of Esophagogastric Variceal Bleeding in Cirrhosis Based on Computational Fluid Dynamics Simulation

摘要: 食管胃底静脉曲张破裂出血(esophagogastric variceal bleeding, EGVB)是肝硬化门静脉高压最严重的并发症之一，其发生与门静脉压力升高、侧支循环重建以及局部血流动力学异常密切相关。传统风险评估方法主要依赖内镜形态学特征及门静脉压力指标，但在反映曲张静脉局部血流动力学环境方面仍存在一定局限。近年来，随着医学影像技术和计算能力的发展，基于计算流体力学(computational fluid dynamics, CFD)的血流动力学分析逐渐被应用于门静脉系统研究，为揭示曲张形成及破裂的生物力学机制提供了新的研究手段。CFD能够基于患者个体化三维血管模型，定量分析血流速度分布、壁面剪切应力及流动结构等关键参数，从而为EGVB风险评估提供潜在的量化指标。本文综述了食管胃底静脉曲张破裂出血的病理生理机制，总结了传统风险评估方法及其局限，并重点介绍了CFD在门静脉系统血流动力学研究中的应用进展，包括建模流程、血流动力学指标体系以及相关研究成果。同时，对当前研究面临的主要挑战及未来发展方向进行了讨论，以期为EGVB个体化风险评估及精准治疗提供新的研究思路。

Abstract: Esophagogastric variceal bleeding (EGVB) is one of the most severe complications of cirrhotic portal hypertension, and its occurrence is closely associated with elevated portal pressure, collateral circulation reconstruction, and local hemodynamic abnormalities. Traditional risk assessment methods primarily rely on endoscopic morphological characteristics and portal pressure indices; however, they have limitations in reflecting the local hemodynamic environment of variceal veins. In recent years, with advances in medical imaging technology and computational power, hemodynamic analysis based on computational fluid dynamics (CFD) has gradually been applied to the study of the portal venous system, offering a new approach to elucidating the biomechanical mechanisms underlying variceal formation and rupture. CFD enables the quantitative analysis of key parameters such as blood flow velocity distribution, wall shear stress, and flow structures based on patient-specific three-dimensional vascular models, thereby providing potential quantitative indicators for EGVB risk assessment. This review summarizes the pathophysiological mechanisms of EGVB, outlines traditional risk assessment methods and their limitations, and focuses on the application progress of CFD in hemodynamic studies of the portal venous system, including modeling workflows, hemodynamic indices, and related research findings. Additionally, the main challenges and future directions in current research are discussed, aiming to provide new insights for individualized risk assessment and precise treatment of EGVB.