门奇断流术对门静脉血液动力学的影响

Effects of portoazygos disconnection on portal hemodynamics

作者采用双功能多普勒超声检测门静脉血流和术中测压的方法观察２０例门静脉高压症患者行门奇断流术（Ｈａｓｓａｂ）前后的门静脉血液动力学变化。结果表明：（１）断流术后门静脉血流量（ＰＶＦ）的增减，主要取决于胃冠状静脉侧支与脾血流量比值（ＣＶＦ／ＳＶＦ）的大小。比值越小，术后ＰＶＦ减少越明显；反之，ＰＶＦ则趋向增加。大多数患者术后ＰＶＦ减少。（２）断流术后肠系膜上静脉血流量有一定增加，是机体维持ＰＶＦ相对稳定的一种代偿性调节反应。（３）门静脉压力与ＰＶＦ非同步变化。断流术后门静脉压力仍维持在较高水平。门奇断流术对门静脉血流量的影响大于对门脉压力的影响。Ｐ＜０．０１：术后６个月与术后２周比较Ｐ＞０．０５术前ＰＶＦ与ＦＰＰ无显著性相关。脾切除后的ＦＰＰ下降量与ＳＶＦ呈正相关（ｎ＝２０，ｒ＝０．６９４，Ｐ＜０．０５），断流术后ＦＰＰ比术前有降低，但无统计学差异。讨论门奇断流术后门静脉血流量是增加抑或减少，各家报道不一［１～３］。断流术阻断了胃冠状静脉等门体侧支，能增加门静脉向肝血流，但断流的同时切除了肿大的脾脏则减少了门静脉血流的来源。这两个因素的对比，决定断流术后门静脉血流的增减，亦即ＣＶＦ／ＳＶＦ比值的大小起重要作用?

Abstract The hemodynamics of portal venous system was studied by Duplex ultrasonography and direct pressure measurement before and after portoazygos disconnection (Hassab operation) in 20 patients with portal hypertension. It was found that after Hassab operation,the change of portal blood flow (PVF) mainly depended on the ratio of blood volum of gastric coronary vein collaerals to that of spleen, ie, the smaller the ratio was, the larger PVF decreased, otherwise, PVF inclined to increase. In most cases, PVF decreased.While ,blood flow of superior mesenteric vein increased as a result of compensation , however ,free portal pressure still maintained in a high level.