摘要
目的了解治疗门静脉高压症的不同术式对门静脉系统血流量的影响。方法应用多普勒超声检测正常对照(NC)者、门静脉高压对照(PH)患者、断流手术(DS)患者、联合手术(CS)患者以及两种手术前后门静脉系统血流量参数。结果 PH 组肠系膜上静脉血流量(SMVF)与脾静脉血流量(SVF)之和大于 NC 组的门静脉血流量(PVF),提示肝硬变门静脉高压症中存在内脏高血流动力状态。在 PH 组,门静脉血流量(PVF)约减少42.8%,冠状静脉分流量(CVF)约58.5%。DS 后近期 PVF 增加,但已有经冠状静脉(CV)的分流,且随时间延长而增加,结果使 PVF 降至 PH 组的水平,CVF 增加可能是术后再出血的原因。CS 后近期血液动力学已趋于平稳,PVF 较 DS 后轻度减少,且无 CV 分流。结论联合手术止血效果好,同时能维持肝功能。
Objective To evaluate the effects of different operations for portal hypertension on portal venous system flow.Method The parameters of portal venous system flow were determined by Doppler ultrasonography (DUS)in normal healthy control(NC),patients with liver cirrhosis and portal hypertension (PH),patients with esophagogastric devascularization combined with spleneetomy (DS) and patients with conventional splenorenal shunt combined with esophagogastric devascularization (CS).Results The sum of superior mesen- teric venous flow (SMVF) and splenic venous flow (SVF) in patients with PH was greater than portal venous flow (PVF) in NC,indicating that there is splanchnic hyperemia in patients with liver cirrhosis and portal hy- pertension.The PVF of patients with PH was lower than that of NC by about 42.8%.About 58.5% of SMVF and SVF was shunted through the coronary vein (CV) to systemic circulation in patients with PH.In patients with DS,PVF increased during the period of first month after operation,along with increased shunting by way of the CV,PVF decreased to the level of that of patients with PH.Portosystemic collateral pathway via the CV de- veloped and exaggerated in patients with DS,which may be responsible for the rebleeding after operation.In pa- tients with CS stable hemodynamic state could be achieved in short time.PVF of patients with CS was a bit low- er than that of patients with DS.Furthermore,no CV shunting was found in patients with CS.Conclusion CS can prevent recurrent variceal bleeding meanwhile maintains liver function.
出处
《中华普通外科杂志》
CSCD
1998年第2期93-95,共3页
Chinese Journal of General Surgery
关键词
门静脉高血压
血液动力学
外科手术
超声检查
Hypertension,portal
Hemodynamics
Surgery,operative
Ultrasonography,doppler
