脾切除贲门周围血管离断术对患者肝功能及肝脏血流动力学的影响  

The function and heamodynamics of liver in patients who received splenectomy and pericardial blood vessels devascularization in the perioperative period

作　　者：张鹰[1] 李志伟[1] 赵新[1] 肖朝辉[1] 刘虎[1] 余灵祥[1] 张培瑞[1] 张绍庚[1] 林折辉 

机构地区：[1]解放军第三○二医院肝胆外科,北京100039

出　　处：《中华肝胆外科杂志》2015年第3期170-172,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨脾切除贲门周围血管离断术治疗肝硬化门脉高压症患者短期内肝脏血流动力学及肝功能变化.方法 回顾性分析2013年1月至2013年6月在我院行脾切除贲门血管离断术的39例肝硬化门脉高压患者的术前及术后相关数据.术中采用玻璃管水柱法测量术前及术后自由门静脉压力（FPP）.应用超声多普勒分别检测手术前后门静脉血流量（PVF）、肝动脉血流量（HAF）.血液生化检查监测术前术后肝功能的变化.结果 本组行脾切断流术的肝硬化门脉高压症患者共39例.FPP由术前的（34.1±0.5）cmH2O（1 cmH2O=0.098 kPa）降至术后的（25.8±0.8）cmH2O （P ＜0.05）;PVF由术前的（1 389.5±89.2） ml/min减少至术后的（875.6±76.8）ml/min（P＜0.05）;HAF由术前的（586.2±61.8）ml/min增加至术后的（894.1 ±72.9） ml/min（P＜0.05）.手术前后肝功Child A级率皆为100％,手术前后肝功无明显差异.结论 脾切除贲门周围血管离断术后患者短期内门脉压力降低,血流量减少.肝动脉血流量增加.手术本身对患者肝脏功能没有显著影响.Objective To investigate the changes in liver function and in haemodynamics of the liver in patients with cirrhosis and portal hypertension who underwent splenectomy and pericardial devascularization.Methods Patients with cirrhosis and portal hypertension treated in our hospital from January 2013 to June 2013 were enrolled into this study.The clinical data were analyzed retrospectively.Results 39 patients with cirrhosis and portal hypertension underwent splenectomy and pericardial devascularization.The portal venous flow （PVF） and the free portal vein pressure （FPP） decreased （1 389.5 ± 89.2 vs 875.6 ± 76.8 ml/min,34.1 ±0.5 vs 25.8 ±0.8 cmH2O （1 cmH2O =0.098 kPa）,respectively） and the hepatic arterial flow （HAF） increased （586.2 ±61.8 vs 894.1 ±72.9 ml/min） after the operation.The proportion of patients with Child Pugh class A was the same before and after the operation.Conclusion For patients who underwent splenectomy and pericardial devascularization,the liver function were stable and the free portal pressure and the portal vein flow decreased,while the hepatic arterial flow increased in the perioperative period.

关 键 词：门脉高压症 肝硬化 脾切除术 贲门周围血管离断术 肝脏血流动力学 肝功能 

分 类 号：R657.34[医药卫生—外科学]