肝动脉栓塞术前、后肝脏血流动力学的实验研究

Experimental Study on Hepatic Perfusion Changes after Transcatheter Arterial Embolization

目的采用CT灌注成像及多普勒血流计测定肝脏血流量,研究肝动脉栓塞术对肝脏血流动力学的影响。材料与方法10头猪麻醉后,行肝左动脉栓塞术。于肝左动脉栓塞术前及术后,采用CT灌注成像测定肝右叶肝动脉灌注量(HAP)、门静脉灌注量(PVP)、总肝血流量(THBF)、肝动脉灌注指数(HPI),采用多普勒血流计分别测定肝门静脉、肝固有动脉、肝左动脉及肝右动脉血流量,并进行对比分析。结果肝左动脉栓塞术前和术后肝脏右叶HAP、PVP、THBF及HPI分别为0.3376ml.min-1.ml-1和0.4023ml.min-1.ml-1、0.9237ml.min-1.ml-1和0.8263ml.min-1.ml-1、1.2613ml.min-1.ml-1和1.2286ml.min-1.ml-1、26.80%和32.74%;肝左动脉栓塞术前和术后肝门静脉、肝固有动脉、肝左动脉、肝右动脉血流量分别为793.04ml/min和987.6ml/min、316.59ml/min和188.90ml/min、164.10ml/min和10.13ml/min、158.83ml/min和186.64ml/min。与肝左动脉栓塞术前相比,栓塞术后肝右动脉血流量及灌注量增加,肝门静脉的血流灌注量减少;术后肝固有动脉血流量明显减少;肝门静脉血流量明显增加,具有统计学意义;随着肝动脉栓塞面积增加,门静脉血流灌注量逐渐增加。结论CT灌注成像可准确地定量测量肝脏血流量;肝动脉栓塞术后,通过肝动脉缓冲效应,门静脉血流量增加,维持全肝血流量基本平衡。

Objective To study hepatic perfusion changes after transcatheter arterialembolization（TAE） with helical CT and doppler rheometer. Materials and Methods Left hepatic artery embolization were performed in 10 anesthesia pigs. Dynamic computer tomograghy perfusion of liver were performed and hepatic arterial perfusion （HAP）, portal venous perfusion （PVP）, total hepatic blood flow （THBF）, hepatic perfusion index （HPI） were measured. Blood flow of portal vein （PV）, proper hepatic artery （PHA）, left hepatic artery （LHA）, right hepatic artery （RHA） were detected with doppler rheometer before and after transeatheter arterial embolization （TAE）, blood flow parameters measured with doppler rheometer were compared with hepatic perfusion parameters of helical CT. Result Before and after TAE, hepatic arterial perfusion （ HAP）, portal venous perfusion （PVP）, total hepatic blood flow （THBF）, hepatic perfusion index （HPI） were 0.3376 ml·min^-1·ml^-11 vs 0. 4023 ml·min^-1·ml^-1, 0. 9237 ml·min^-1·ml^-1 vs 0.8263 ml·min^-1·ml^-1, 1.2613 ml·min^-1·ml^-1 vs 1.2286ml·min^-1·ml^-1, 26.80% vs 32. 74% ,respectively; blood flows of PV, PHA, LHA, RHA were 793.04 ml/min vs 987.6 ml/min,316.59 ml/min vs 188.90 ml/ min,164.10 ml/min vs 10.13 ml/min, 158.83 ml/min vs 186.64 ml/min respectively. Comparing to pigs before TAE, blood flows of RHA and HAP of right hepatic lobar increased significantly, but portal vein perfusion of right hepatic lobar was decreased after TAE; blood flows of PHA was decreased significantly and blood flows of PV was increased significantly ; THBF was decreased signifieandy and blood flows of PV was increased significantly; THBF was unchanged after TAE. With the proportion of hepatic artery embolism increased, the blood flow of PV was increased gradually. Conclusion Dynamic CT perfusion of liver can measure the hepatic perfusion parameters accurately. Hepatic buffer response plays an important role in keeping the balance of hepatic hemodynamics after TAE. These perfusion parameters change correlate significantly with the proportion of hepatic artery embolism.