肝硬化门静脉高压症患者超声内镜引导门静脉压力梯度测定:附52例报告  

Endoscopic ultrasound-guided portal pressure gradient measurement in patients with cirrhotic portal hypertension:a report of 52 cases

作　　者：雷钊[1,2,3] 罗蓉昆 卢焕元[1,2] 张瑞 罗宏武[1] 罗少彬 宋锦涛[1] 伍园园 蒋志云[1] 彭茜茜 尹欣林 刘浔阳 黄飞舟[1,2,3] 邓刚[1,2,3] LEI Zhao;LUO Rongkun;LU Huanyuan;ZHANG Rui;LUO Hongwu;LUO Shaobin;SONG Jintao;WU Yuanyuan;JIANG Zhiyun;PENG Qianqian;YIN Xinlin;LIU Xunyang;HUANG Feizhou;DENG Gang(Department of Hepatopancreatobiliary and Portal Hypertension Surgery,the Third Xiangya Hospital,Central South University,Changsha 410013,China;Hunan Treatment and Research Center for Portal Hypertension,Changsha 410013,China;Institute of Minimally Invasive Surgery,Central South University,Changsha 410013,China;Department of Anesthesiology,​the Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院肝胆胰门静脉高压症外科,湖南长沙410013 [2]湖南省门静脉高压症治疗研究中心,湖南长沙410013 [3]中南大学微创外科研究所,湖南长沙410013 [4]中南大学湘雅三医院麻醉科,湖南长沙410013

出　　处：《中国普通外科杂志》2023年第1期101-109,共9页China Journal of General Surgery

基　　金：湖南省自然科学青年基金资助项目(2020JJ5853)。

摘　　要：背景与目的:门静脉高压症的特征是门静脉压力梯度(PPG)增加,然而,传统的PPG测定方法困难、风险大,临床很难常规实施。前期的动物实验及人体试验均显示了超声内镜引导门静脉压力梯度(EUS-PPG)测定技术的可行性及准确性,且近期一项前瞻性研究在肝小静脉闭塞所致的急性或亚急性门静脉高压症患者中验证了EUS-PPG与肝静脉压力梯度(HVPG)存在一致性。然而,对于肝硬化门静脉高压症患者进行EUS-PPG测定的相关临床研究在国内尚未见相关报道。因此,本研究探讨肝硬化门静脉高压症EUS-PPG测定的准确性、可行性及安全性。方法:选取2022年3月—2022年8月中南大学湘雅三医院收治的52例肝硬化门静脉高压症进行EUSPPG测定,分析EUS-PPG测定结果及其与患者临床特征的关系。结果:52例患者中,47例既往或近期有食管胃静脉曲张出血史(14例既往经历过脾切除断流手术)。51例(98%)成功实施EUS-PPG,1例技术失败。门静脉穿刺途径分别为经胃壁(42例)或经十二指肠(9例),经胃壁穿刺肝静脉(10例)或肝后下腔静脉(41例),操作时长(15.5±3.4) min。51例患者的平均门静脉压力值(21.0±7.1) mmHg,肝静脉压力值(5.7±5.5) mmHg,PPG为(15.3±4.9) mmHg。5例患者同期分别穿刺门静脉和胃左静脉测压,两者压力值结果显示高度相关性(r=0.99,P=0.000 66)。所有患者均未观察到不良事件。既往行脾切除断流手术患者PPG明显低于未经历该手术的患者(12.8 mmHg vs. 16.3 mmHg,P<0.05);有食管胃底静脉曲张破裂出血史患者PPG明显高于无该病史的患者(16.8 mmHg vs. 11.8 mmHg,P<0.05);不同肝功能Child-Pugh分级患者间EUS-PPG差异无统计学意义(P>0.05)。结论:EUS-PPG是门静脉和肝静脉压力差值直接测定新方法,该方法准确可靠、操作安全可行。当常规途径门静脉穿刺存在技术困难时可选择经过十二指肠穿刺门静脉或穿刺扩张的门静脉主要属支代替。Background and Aims: Portal hypertension is characterized by an increased portal pressure gradient(PPG). However, the conventional method for PPG measurement is difficult and risky, so it is challenging to implement in a clinical setting routinely. Previous animal experiments and human tests have shown the feasibility and accuracy of the endoscopic ultrasound-guided portal pressure gradient(EUS-PPG) measurement techniques. A recent prospective study involving patients with subacute portal hypertension caused by occlusion of the small hepatic veins verified the consistency between EUS-PPG and hepatic venous pressure gradient(HVPG). However, there is no report assessing EUS-PPG measurement in patients with cirrhotic portal hypertension in China. Therefore, this study was performed to investigate the accuracy, feasibility, and safety of EUS-PPG measurement in cirrhotic portal hypertension.Methods: A total of 52 patients with cirrhotic portal hypertension admitted to the Third Xiangya Hospital of Central South University from March 2022 to August 2022 were enrolled for EUS-PPG measurement. The EUS-PPG measurement results and their associations with the clinical features of patients were analyzed.Results: In the 52 patients, 47 cases had a previous or recent history of esophageal and gastric variceal bleeding(14 cases had previous devascularization and splenectomy). EUS-PPG was successfully performed in 51 cases(98%), and technical failure occurred in one case. The approaches for portal vein puncture included that through the gastric wall(42 cases) or the duodenum(9 cases) and punch of the hepatic vein(10 cases) or retrohepatic inferior vena cava(41 cases) through the gastric wall. The operative time was(15.5±3.4) min. Of the 51 patients, the average portal vein pressure was(21.0±7.1) mmHg, the hepatic vein pressure was(5.7±5.5) mmHg and the PPG was(15.3±4.9) mmHg. Five patients underwent simultaneous portal vein and left gastric vein puncture for pressure measurement, and the results showed that the two pressure

关 键 词：高血压 门静脉 肝硬化 门静脉压力梯度 超声内镜 

分 类 号：R657.3[医药卫生—外科学]