门静脉高压症患者的门静脉压对胰腺血运及功能的影响  

The effect of portal vein pressure on pancreatic blood flow and function in patients with portal hypertension

作　　者：谢小丰 龚维 秦威 祝洋 朱新林 XIE Xiaofeng;GONG Wei;QIN Wei;ZHU Yang;ZHU Xinlin(Department of General Surgery,the 921st Hospital of the Joint Logistics Support Force of the People's Libera-tion Army of China,Changsha 410003,Hunan,China)

机构地区：[1]中国人民解放军联勤保障部队第九二一医院普外科,湖南长沙410003

出　　处：《中国现代手术学杂志》2023年第6期435-438,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨门静脉高压症患者的门静脉压对胰腺血运及功能的影响。方法选取2016年1月至2022年12月本院收治的肝炎后肝硬化门静脉高压症并有食道胃底静脉曲张破裂出血史的患者50例,随机分为两组,每组各25例,观察组采用门体部分分流加贲门周围血管离断术;对照组单纯行贲门周围血管离断术。比较两组手术前后稳定期门静脉压(portal vein pressure,PVP),手术前后胰腺平扫、增强扫描CT值的变化,进腹后、关腹前脾静脉及胰横动脉血流速度及手术前后胰腺内、外分泌指标血C肽及粪弹力蛋白酶-1浓度的变化。结果观察组术后PVP明显低于对照组(P<0.01)。两组术前胰腺平扫、增强扫描CT值及增加值无明显差异(P>0.05)。观察组术后胰腺增强扫描CT值、增加值均明显高于对照组(P<0.01)。入腹后彩超测脾静脉(pv1)、胰横动脉(sv1)血流速度,两组无明显差异(P>0.05),关腹前再次测其速度(pv2,sv2),观察组明显快于对照组(P<0.01)。两组术前血C肽无明显差异(P>0.05),观察组术后1、3、5、7 d高于对照组同时相(P<0.01)。两组术前粪弹力蛋白酶-1无明显差异(P>0.05),观察组术后5、8、10 d高于对照组同时相(P<0.01)。结论门静脉高压症经门体部分分流适当降压后既可有效地治疗曲张静脉破裂出血,又可明显改善门静脉系统血流淤滞状态,内脏器官血液循环改善,其相应功能也得以增强。Objective To explore the impact of portal vein pressure on pancreatic blood flow and functions in patients with portal hypertension.Methods Fifty patients with post hepatitis cirrhosis portal hypertension and a history of esophageal and gastric variceal bleeding admitted to our hospital from January 2016 to December 2022 were selected.They were randomly divided into two groups according to random number table.The observation group was operated with partial portosystemic shunt combined with pericardial vascular dissection.And the control group received simple pericardial vascular dissection.It was compared of the postoperative stable portal vein pressure(PVP),changes in pancreatic enhanced CT values,blood flow velocity in the splenic vein and transverse pancreatic artery between two groups,and the serum fasting C-peptide(FCP)and fecal elastase-1(FE-1)changes.Results The postoperative PVP of the observation group was significantly lower than that of the control group(P<0.01).There was no statistically significant difference in CT values and added values between the two groups of preoperative pancreatic plain scan and enhanced scan(P>0.05).The CT val-ue and added value of postoperative pancreatic enhancement scan of the observation group were significantly higher than those of the control group(P<0.01).There was no statistically significant difference in the blood flow velocity of the splenic vein(pv1)and the transverse pancreatic artery(sv1)between the two groups using color Doppler ultrasound after laparotomy(P>0.05).Before abdominal closure,their velocities(pv2,sv2)were measured again,and the observation group was significantly faster than the control group(P<0.01).There was no statistically significant difference in preoperative FCP levels between the two groups(P>0.05),while the observation group showed higher levels than the control group at 1,3,5,and 7 days after surgery(P<0.01).There was no statistically significant difference in FE-1 between the two groups before surgery(P>0.05),while the observation group

关 键 词：高血压 门静脉 断流术 脾肾分流术 胰腺功能 

分 类 号：R575[医药卫生—消化系统]