不同手术方式对门静脉高压症病人肝功能性血流量的影响  

Effects of various operations on functional hepatic flow in cirrhotic patients with portal hypertension

作　　者：吴性江[1] 潘峥[1] 韩建民[1] 李为苏[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院普通外科,210002

出　　处：《腹部外科》2004年第6期334-336,共3页Journal of Abdominal Surgery

摘　　要：目的　探讨TIPS、断流术、断流加分流术对肝功能性血流量的影响。方法　本组肝硬化门静脉高压症病人 37例 ,行TIPS治疗 8例、断流术 10例、TIPS +门奇静脉断流术 10例、门奇断流+脾肾分流术 9例。采用超声多普勒、D 山梨醇 (SOD)清除率和直接门静脉测压检测手术前后肝总血流量、肝功能性血流量和门静脉压。结果　术前病人门静脉、肝动脉和肝总血流量显著增加 ,肝功能性血流量显著下降 ,ChildC级病人下降更为显著。TIPS、TIPS +断流术和断流 +脾肾分流术后门静脉压力和肝功能性血流量均明显下降 (P <0 .0 5 )。其中 ,TIPS术后肝功能性血流量下降显著大于TIPS +断流术和断流 +脾肾分流术。断流术病人门静脉压和肝功能性血流量无明显变化。结论　肝功能性血流是评估肝脏储备功能的重要指标 ,分流术在降低门静脉压力同时减少肝功能性血流量。Objective To evaluate the changes of functional hepatic flow in cirrhotic patients with portal hypertension before and after transjugular intrahepatic portasystemic shunt(TIPS),portal-azygos disconnection,portal-azygos disconnection with TIPS,and portal-azygos with central splenorenal shunt.Methods Thirty-seven patients with portal hypertension were treated with TIPS in 8 patients,portal-azygos disconnection in 10 patients,portal-azygos disconnection with TIPS in 10 patients and portal-azygos with central splenorenal shunt in 9 patients.Total hepatic flow,functional hepatic flow and direct portal pressure were determined by means of the D-sorbitol clearance,Doppler sonography and direct measurement of portal pressure.Results Portal venous flow,hepatic arterial flow and total hepatic flow were increased and functional hepatic flow was decreased in cirrhotic patients with portal hypertension.Functional hepatic flow in grade C was significantly less than in grade A and B.Portal pressure and functional hepatic flow were decreased after TIPS,portal-azygos disconnection with TIPS and portal-azygos with central splenorenal shunt.Functional hepatic flow in patients with TIPS was significantly less than in patients with portal-azygos disconnection with TIPS and portal-azygos disconnection with central splenorenal shunt.There were no changes in functional hepatic flow and portal pressure after portal-azygos disconnection.Conclusion Functional hepatic flow is a valuable index for the evaluation of hepatic reserve function.The decreases of portal pressure and the reduction of function flow occur after shunt operation.

关 键 词：血流量 肝功能 病人 断流术 TIPS 脾肾分流术 门静脉压力 门静脉高压症 术后 治疗 

分 类 号：R657[医药卫生—外科学] R575[医药卫生—临床医学]