脾肾分流加断流联合术血流动力学变化的临床研究

CLINICAL STUDY OF SPLANCHNIC HEMODYNAMICS BEFORE AND AFTER SPLENORENAL SHUNT COMBINED WITH HASSAB OPERATION IN PATIENT WITH PORTAL HYPERTENSION

本文利用彩色多普勒血流显象（ＤＣＦＩ）数字减影血管造影（ＤＳＡ）和术中门静脉压力测量，研究了脾肾分流加贲门周围血管离断联合术后门脉系统血流动力学变化。结果表明联合术后门静脉内径和压力较断流术明显减小和降低，但门静脉血流量的减少与断流术无显著差异（ｐ＞０．０５）；同时发现联合术后门静脉血流量仍维持正常高值水平，门静脉为向肝血流，脾静脉为逆肝血流，门静脉肝内灌注良好，门静脉头向侧枝全部消失，以上血流动力学变化与本组病例术后再出血及脑病发生率低，腹水消退和生活质量好有关。本研究表明，脾肾分流加贲门周围血管离断联合术是合理而可取的一种术式。

In this study, hemodynamic changes of the portal system were observed and analysed with DCFI and DSA in patients with portal hypertension before and after operation. The results showed that the portal vein diameters were markedly reduced after operation in patients who underwent splenorenal shunt combined with Hassab operation(combined operation)compared with patients who underwent only Hassab operation(P<0. 05), and the degree of the reduction of portal blood flow was no significant difference between Hassab operation and combined operation (P>0.05). In the combined operation group, the portal hepatopetal blood flow was still maintained at normal value, and the splenic vein blood flow was hepatofugal. The hemodynamic changes above correlated with low incidence of rebleeding and encephalopathy, ascites disappear and good quality of life. The results indicate that the operation of splenorenal shunt combined with Hassab operation is an effective and rational procedure for portal hypertension.