肝门部胆管癌术前门静脉栓塞的血流动力学与肝再生的关系  

Relationship between hemodynamics and liver hypertrophy in patients with portal vein embolization before surgery for hilar cholangiocarcinoma

作　　者：易滨[1] 梁丽琼[2] 王茵[3] 程庆宝[1] 邱应和[1] 郭佳[1] 姜小清[1] 吴孟超[1] 

机构地区：[1]第二军医大学东方肝胆外科医院胆道一科,上海200438 [2]第二军医大学东方肝胆外科医院超声科,上海200438 [3]第二军医大学附属长海医院超声科,上海200438

出　　处：《中华消化外科杂志》2011年第2期113-115,共3页Chinese Journal of Digestive Surgery

基　　金：上海市卫生局局级项目（2007Y29）;国家民政部课题[民人教科字（2008）47-2-39]

摘　　要：目的 研究肝门部胆管癌术前门静脉栓塞（PVE）前后血流动力学的变化,并分析其与非栓塞肝叶增生速度的关系.方法 回顾性分析2008年4月至2009年12月第二军医大学东方肝胆外科医院收治的21例肝门部胆管癌患者的临床资料.在手术治疗前进行钢圈PVE治疗,在该治疗前和治疗后第3、7、14天采用彩色多普勒超声对门静脉的血流动力学指标进行测量、分析.计量资料比较采用Student t 检验,双变量正态分布数据相关分析采用线性相关分析方法.结果 本组患者门静脉主干压力在PVE治疗后为（25.9±4.1）cm H2O（1 cm H2O=0.098 kPa）,高于PVE治疗前的（22.4±4.1）cm H2O,升高幅度达到（3.5±2.5）cm H2O（t=-6.504,P＜0.05）;门静脉非栓塞支血流速度在PVE治疗后加快,第7天血流速度达到峰值（26±9）cm/s;非栓塞肝叶增生速度与栓塞肝叶血管床占全肝体积比呈正相关（r=0.593,P＜0.05）.结论 栓塞的门静脉血管床范围越大,PVE诱导的非栓塞肝叶增生速度越快.Objective To detect the changes of hemodynamics in patients with portal vein embolization （PVE） before surgery for hilar cholangiocarcinoma, and analyze the relationship between hemodynamics and liver hypertrophy. Methods The clinical data of 21 patients with hilar cholangiocarcinoma who were admitted to the Eastern Hepatobiliary Surgery Hospital from April 2008 to December 2009 were retrospectively analyzed.Relevant hemodynamic variables were detected and analyzed before and 3, 7, 14 days after PVE. Data were processed using Student t test or linear correlation analysis. Results The main portal vein pressure after PVE was （25.9 ± 4.1 ） cm H2O （ 1 cm H2O = 0.098 kPa）, which was （ 3.5 ± 2.5 ） cm H2O higher than that before PVE [（ 22.4 ± 4.1 ） cm H2O] （ t = - 6. 504, P ＜ 0.05 ）. The blood flow velocity in the non-embolized branch of portal vein increased after PVE, and reached peak [（26 ±9）cm/s] at the seventh day after PVE. A positive correlation was found between the hypertrophic rate of the non-embolized lobes and the ratio of embolized lobes to total liver volume （ r = 0. 593, P ＜ 0. 05 ）. Conclusion Greater scope of the embolized vascular bed of portal vein induces higher hypertrophic rate of non-embolized liver.

关 键 词：胆管肿瘤 肝门部 门静脉栓塞 血流动力学 

分 类 号：R735.8[医药卫生—肿瘤]