肝硬化门脉分段血流量的变化:部分脾动脉栓塞术的有益作用  

Changes of Segmental Blood flow volume of the Portal Vein in Patients with Cirrhosis:the Beneficial effects of Partial Splenic Embolization

作　　者：黄群[1] 刘俊[1] 陈小珠[2] 吴斌[1] 陈幼祥[1] 尹秀玲[1] 胡伟[1] 王崇文[1] 

机构地区：[1]江西医学院第一附属医院消化内科,江西南昌330006 [2]江西医学院第一附属医院超声科,江西南昌330006

出　　处：《实用临床医学（江西）》2000年第1期7-10,共4页Practical Clinical Medicine

基　　金：江西省科委资助

摘　　要：目的 :应用彩色多普勒超声技术测量肝硬化患者部分脾动脉栓塞术 (PSE)前后门脉不同部位的血流量 ,以研究PSE对肝硬化门脉血流量的影响及PSE降低门脉压力的血流动力学机制。方法 :2 8例肝硬化患者分别于PSE术前 1周和术后 2～ 3周 ,应用彩色多普勒超声仪对其脾门静脉 (SPV)、肠系膜上静脉 (SMV)、门脉主干 (MPV)、门脉左支 (LPV)和门脉右支 (RPV)的血流量进行测定。PSE术使用的栓塞材料为 10mm× 2mm× 2mm大小的明胶海绵细条 ,每例患者脾脏栓塞的面积控制在 6 0 %～ 70 %。结果 :肝硬化患者PSE术后门脉不同部位的血流量有不同程度的减少 ,特别是SPV和MPV减少为甚 ,分另减少了 6 9.7% (P <0 .0 1)和 42 .6 % (P <0 .0 5 ) ,但LPV与RPV的血流量之和并未明显减少。术前门脉左侧 (SPV +SMV)的血流量明显高于门脉主干或门脉右侧 (LPV +RPV)的血流量 ,两者的差值分别为 12 83 .17± 846 .10ml/min和 1186 .36± 6 49.5 4ml/min ,术后分别下降至 46 3.5 3± 2 81.15ml/min(P <0 .0 2 )和 96 .36± 5 0 .42ml/min(P <0 .0 0 0 1)。结论 :PSE能有效减少肝硬化患者门脉血流量 ,且不以营养肝细胞的门脉血流量的降低为代价 ;肝硬化门脉左侧与门脉主干或门脉右侧的血流量的差值可能是门一体分流血流量的主要来源 。Aim:In order to study the influence of partial splenic embolization (PSE) on the segmental blood flow volume (BFV) of the portal vein (PV) in patients with cirrhosis,We determined BFV in different segments of PV before and after PSE with color Doppler flow imaging. Patients and methods:With color Doppler flow imaging,the segmental BFV of PV were determined in 28 patients with cirrhosis 1 week before and 2～3 weeks after PSE.The vein observed included splenic portal vein (SPV),superior mesenteric vein (SMV),main portal vein (MPV),left portal vein (LPV), and right portal vein (RPV).The material used for splenic embolization was the small pieces of gelfoam.The area of the splenic embolization for each patient was about 60%～70%. Results:After PSE,BFV of different sites of PV decreased,especially in SPV and MPV.BFV of them decreased by 69.7%( P <0.01) and 42.6%( P <0.05),respectively.While BFV of right sided PV (LPV+RPV) did not change.Before PSE、BFV of the left-sided PV (SPV+SMV) was markedly higher than that in MPV or in right sided PV.The differences between the left sided PV and MPV or the right sided PV were 1283.17±864.10 ml/min and 1186.36±649.54 ml/min,respectively.After PSE these differences significantly decreased 463.53±281.15 ml/min( P <0.02) and 96.36±50.42 ml/min ( P <0.0001) respectively. Conclusions:In patients with cirrhosis,although PSE may markedly diminish BFV of PV,BFV did not decrease too much to nourisn the hepatic cells.The differences of BFV betwwen left sided PV and MPV or right sided PV may be the main sources of the portal system shunts,which are significantly lowered by PSE.

关 键 词：肝硬化 门脉高压 彩色多普勒超声 血流动力学 

分 类 号：R575.2[医药卫生—消化系统]