射频消融治疗脾功能亢进症对门静脉系统血流动力学的影响

Clinical study of the portal hemodynamic influence of hypersplenism patients treated by radiofrequency ablation

目的探索肝硬化门脉高压性脾功能亢进症在射频消融(radiofrequencyablation,RFA)治疗前后门静脉血流动力学的变化。方法在全麻、超声引导下经皮、经腹腔镜下及开腹术中对28例临床确诊肝硬化脾功能亢进症的患者行RFA治疗。于治疗前后用彩色多普勒超声检测门静脉(PV)、脾静脉(SV)主干的血流动力学指标。10例开腹术中患者于胃网膜右静脉置管测自由门静脉压(freeportalpress,FPP)。结果18例患者射频消融术后门静脉及脾静脉血管内径无明显差异,最大血流速度与术前比较明显减小,有显著差异(P<0.05)。门静脉及脾静脉血流量均较术前明显减少,与术前比较有显著差异(P<0.05)。脾静脉血流量较术前减少幅度较大,减少(46.14±10.45)%;门静脉血流量较术前减少幅度较小,减少(35.36±9.17)%;10例患者RFA治疗前FPP(39.13±2.85)cmH2O,治疗后FPP(36.50±2.33)cmH2O,术后FPP较术前明显降低约3～4cmH2O,治疗前后存在非常显著差异(P<0.01)。所有患者术后均未发现门静脉系统内有血栓形成。结论RFA治疗脾亢在改善脾亢患者外周血象的同时可明显减少门静脉血流量和降低门脉压力,这种血流动力学的改变可减轻食道胃底静脉曲张程度;保持一定的脾脉血流也使术后门静脉血栓形成的几率大为降低。

Objective To evaluate the portal hemodynamic changes of patients with hypersplenism before and after radiofrequency ablation (RFA). Methods Under systemic anaesthesia and untrasound guidance, 28 patients with hypersplenism were treated with RFA under laparoscopic or percutaneous guidance or in open operation. Before and after the operation, all patients' hemodynamic datas of the portal system were measured by Doppler ultra-sonography. 10 patients' free portal press (FPP) were measured by a catheter in the right gastroepiploic vein. Results Compared with the condition before operation, there were no significant changes in the diameter of the portal vein in 18 patients after RFA. The maximum velocity and the flow of the portal vein and the spleen vein were significantly reduced. The portal vein thrombosis (PVT) were not detected in all patients after operation. Conclusions Radiofrequency ablation for hypersplenism has excellent curative effect and can significantly decrease the press and the flow of the portal vein as well, which can alleviate the extend of (esophageal) varics and prevent the portal vein thrombosis.