断流加分流联合术的门静脉血流动力学变化与临床疗效  

Portal Hemodynamics and the Clinical Effects of Devascularization Combined with Splenorenal Shunt for Portal Hypertension

作　　者：汪昱[1] 郑起[1] 冯昌宁[1] 

机构地区：[1]上海市第六人民医院外科,200233

出　　处：《外科理论与实践》2000年第2期111-113,共3页Journal of Surgery Concepts & Practice

摘　　要：目的：前瞻性分析门奇静脉断流加脾肾静脉分流术（联合手术）和断流术后的门静脉血流动力学变化与临床疗效。方 法：彩色多普勒超声监测各手术组门静脉系统血流动力学变化，随访临床疗效。结果：联合手术组ＰＶＤ术后平均下降０．２０ ｃｍ（１５．８７％）、ＰＶＦ平均下降２８８．２９ｍｌ／ｍｉｎ（４１．１５％），ＦＰＰ平均Ｆ降０．６６ｋＰａ（１７.４１％）；断流组ＰＶＤ平均下降０．１３ｃｍ（９．２９％）， ＰＶＦ平均下降２００．７０ｍｌ／ｍｉｎ（３０．３５％），ＦＰＰ平均下降０．３８ｋＰａ（１０．５６％）；联合手术组与断流组比较ＰＶＤ有明显差异（Ｐ＜ ０．０１）。再出血率分别为２.９％和１３．８％（Ｐ＜０.０５），肝性脑病率分别为５．７％和３.５％（Ｐ＜０．０５）。结论：联合手术组的门静脉血 流动力学变化及临床疗效优于断流组。To study prospectively the change in portal hemodynamics and the clinical effects of splenorenal shunt combined with porta-azygous devascularization (combined therapy) in comparison with simple porta- azygous devascularization for portal hypertension. Methods: Doppler sonography was used to observe the change in portal hemodynamics and the patients of both groups were carefully followed up. Results: When compared to their corresponding pre-operative values, the portal vein diameter(PVD) was reduced 0.20cm (15.87%), the portal vein flow(PVF) dropped 228.29ml/min(41.15%) and the free portal pressure(FPP) dropped 0.66kpa(17.41%) in the combined therapy group; while the PVD was reduced 0.13cm(9.29%), the PVF dropped 200.70ml/min(30.35%) and the FPP dropped 0.38kPa(10.57%) in the devascularization group. The degree of change in PVD differred significantly between the two groups(P<0.01), the respective rebleeding rate was 2.9% vs 13.8%(P<0.05), and the rate of encephalopathy close to each other(5.7% vs 3.5%,P<0.05). Conclusions: As judged from the clinical effects and the change in portal hemodynamics, combined therapy is to be preferred than the devascularization procedure.

关 键 词：门脉高压症 血流动力学 断流术 脾肾静脉分流术 

分 类 号：R657.3[医药卫生—外科学]