脾切除贲门周围血管离断术后肝脏血流动力学和储备功能的变化  

Liver functions after periesophagogastric devascularization

作　　者：张宇[1] 文天夫[1] 陈哲宇[1] 严律南[1] 梁冠林[1] 李国[1] 张显华[1] 冉顺[1] 廖志学[1] 

机构地区：[1]四川大学华西医院肝移植中心,成都610041

出　　处：《中华普通外科杂志》2009年第6期470-472,共3页Chinese Journal of General Surgery

摘　　要：目的研究脾切除贲门周围血管离断术后肝脏血流动力学及肝功能储备的变化。方法对2006年6月至2007年8月在四川大学华西医院行脾切除贲门周围血管离断术的连续30例乙肝后肝硬化患者通过感应器连续测定手术中的门静脉压力梯度；运用彩色多普勒分别测量术前和术后肝动脉血流量、门静脉血流量、肝动脉阻力指数，通过术前和术后吲哚青绿试验分别测得有效肝血流量及ICGR15。结果本组30例患者的门静脉压力梯度在开腹后为（19±4）mmHg，结扎脾动脉后为（14±4）mmHg，脾切除后为（14±3）mmHg，贲门周围血管离断术后为（12±4）mmHg，有逐渐下降的趋势。术后门静脉血流量由（42±14）ml／s降至（16±8）ml／s，而肝动脉血流量代偿性增加。术后有效肝血流量由（0．48±0．10）L/min增至（0．56±0．10）L/min，而ICGR15由22％±8％减至18％±4％。结论脾切除贲门周围血管离断术后，尽管门静脉压力梯度及门静脉血流量减少，但肝功能储备至少在术后短期内是得到了改善的。Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascularization. The PVPG （portal venous pressure gradient ） was measured by inductor continually during operation. The HAF （hepatic artery flow）, PVF （portal venours flow） and hepatic arterial RI（ resistant index） were measured with Doppler sonography. The EHBF（ effective hepatic blood flow） and ICGR15 （indocyaninegreen retention rate at 15 minutes） were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy （ 19 ± 4 ） mm Hg, ligating the splenic artery（ 14 ± 4 ） mm Hg, splenectomy （ 14 ± 3 ） mm Hg and periesophagogastric devascularization （ 12 ± 4 ） mm Hg showed a tendency to decrease progressively. The PVF decreased [ from （42 ± 14） ml/s to （ 16 ± 8） ml/s] and HAF increased in compensation after operation. The EHBF increased [from （0.48 ±0. 10） L/min to （0. 56 ± 0. 10） L/min], and the ICGR15 decreased （from 23% ± 8% to 18%± 4% ） postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.

关 键 词：高血压 门静脉 肝硬化 脾切除术 血流动力学 断流术 

分 类 号：R686[医药卫生—骨科学]