选择性脾胃区减断分流术后血流动力学变化的实验研究  

Hemodynamic changes after selective decongestive devascularization shunt of gastrosplenic region in portal hypertension dogs

作　　者：张谊[1] 廖毅[1] 陈云志[1] 张启瑜[1] 吴琪[2] 陶崇林[1] 

机构地区：[1]温州医学院第一附属医院肝胆外科 ,浙江325000 [2]温州医学院第一附属医院超声科 ,浙江325000

出　　处：《中华肝胆外科杂志》2009年第11期832-834,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：浙江省科技厅基金资助项目（2007G60G2090011）;温州重市科委资助项目（Y2003A148）

摘　　要：目的研究门静脉高压症犬行选择性脾胃区减断分流术（selective decongestive devascularization shunt of gastrosplenic region,SDDS-GSR） 后血流动力学变化。方法用正常犬制备门静脉高压脾亢模型并进行SDDS-GSR术。制模前、成模后，分流术后30d和术后60d观察门静脉压力，门静脉、肝动脉、脾静脉和脾动脉的内径、血流速度和血流量参数的变化，作自身对照研究。结果SDDS-GSR术后30d的脾胃区静脉压力显著下降（P〈0．01），门静脉、脾动脉和脾静脉内径显著缩小（P〈0．01），门静脉、脾动脉和脾静脉血流量参数减少（P〈0．01），肝动脉内径和血流量参数显著增加（P〈0．01），术后60d上述指标改变仍保持稳定。结论SDDS-GSR术通过减少脾动脉血流和改善脾静脉回流，有效地降低了脾胃区的静脉压力，并保持肠系膜区的相对高压，同时增加肝动脉向肝血流量，保证了门脉的向肝血流量，术后血流动力学变化较持久稳定，是一种合理而可取的治疗门静脉高压症的术式。Objective To study the changes of hemodynamics after selective decongestive devas cularization shunt of gastrosplenic region（SDDS-GSR） for treatment of portal hypertensive dogs. Methods SDDS-GSR were performed on portal hypertensive dogs. The portal venous pressure, hemodynamic parameters of portal vein, hepatic artery, spleen artery and vein were measured regularly. Results In 30 days after SDDS GSR, the venous pressure in the gastrosplenic area decreased obviously （P〈0.01）. Compared with those preoperative values, the parameters of blood flow in portal vein, splenic artery and vein markedly reduced （P〈0.01） and the inner diameters of aforesaid vessels were narrowed （P〈0.01）, while the inner diameter and the parameters of blood flow in hepatic artery in creased （P〈0.01）. In 60 days after the operation, the changes of aforesaid parameters were still sig nificant as compared with those preoperative values （P〈0. 01）. Conclusion SDDS GSR can decrease the venous pressure in the gastrosplenic area significantly while maintain portal perfusion by reducing the parameters of blood flow in splenic artery and ameliorating the resistance splenic vein blood current. It is reasonable and reliable for surgical management of portal hypertension.

关 键 词：高血压 门静脉 脾动脉 远端脾肾分流 血流动力学 

分 类 号：R657.34[医药卫生—外科学]