门静脉高压症的不同手术方式对门静脉系统血流动力学的影响  

Effects of various surgical procedures on portal hemodynamics in patients with portal hypertension

作　　者：张曙光[1] 阮长乐[1] 于振海[1] 李光新[1] 李荔[1] 刘爱莲[1] 

机构地区：[1]山东省千佛山医院普外科,济南250014

出　　处：《中华普通外科杂志》2002年第3期143-145,共3页Chinese Journal of General Surgery

摘　　要：目的测定脾肾分流术 (SRS)、贲门周围血管离断术 (PCDV)及SRS +PCDV手术前后血流动力学变化 ,并评价这些术式在门静脉高压症治疗中的价值。方法应用彩色多普勒检测 99例门静脉高压症患者手术前后门静脉系统血流动力学的状况 ,术中动态测量门静脉压力。结果 (1)脾肾分流组术后较术前门静脉血流量 (PVF)减少 (5 7± 9) % ,门静脉自由压 (FPP)下降 (5 2± 5 ) % ,差异有显著意义 (P <0 0 1)。 (2 )断流组术后较术前PVF减少 (8± 5 ) % ,与术前差异无显著意义 (P >0 0 5 ) ;FPP减少 (19± 7) % ,与术前差异有显著意义 (P <0 0 5 )。 (3)SRS +PCDV组术后PVF减少(36± 8) % ,FPP下降 (34± 10 ) % (P <0 0 5 )。 (4 )SRS +PCDV组术后的PVF和FPP均介于断流组与脾肾分流组之间 ,且各组之间差异有显著意义 (P <0 0 5 )。结论 (1)断流术后门静脉高压瘀血状态依然存在 ;(2 )脾肾分流术后门静脉高压瘀血状态有所缓解 ,门静脉血流肝内灌注减少 ;(3)分流加断流术后PVF和FPP改变不太大 。ObjectiveTo study the effects on hemodynamics of portal venous system of splenorenal shunt plus pericardia devascularization (SRS+PCDV), and evaluate the clinical significance of this operative procedure.MethodsThe hemodynamic parameters of portal venous system by Doppler color-flow imaging (DCFI) of 99 patients with portal hypertension (PH) were measured before and after operation.Results(1)In SRS group the postoperative portal venous flow (PVF), free portal pressure(FPP) decreased by (57±9)%, (52±5)% respectively (P<0.01).(2) In PCDV group PVF decreased by (8±5)% (P<0.05), FPP decreased by (19±7)% (P>0.05).(3)In SRS+PCDV group PVF,FPP decreased by (36±8)%, (34±10)% respectively(P<0.05). (4)The postoperative decrease of PVF and FPP in SRS+PCDV group were between that of SRS and PCDV groups and the difference among the groups was statistically significant (P<0.05).Conclusions(1) The portal blood stasis remained in patients undergoing devascularization. (2) The congestive status of portal vein relieved after SRS, but the hepatic perfusion from portal vein decreased significantly.(3) SRS+PCDV decreases PVF and FPP moderately and effects a significant decrease in recurrent bleeding rate.

关 键 词：脾肾分流术 血液动力学 门脉高压症 术式 门静脉系统 影响 

分 类 号：R657.3[医药卫生—外科学]