断流术中门静脉压力变化及术后再出血的临床研究

A study on the relationship between post-devascularization portal pressure and rebleeding in portal hypertensive patients

目的 分析断流术中自由门静脉压（FPP）的变化与术后再出血的关系，探讨在断流术中是否可以FPP作为加做分流手术的血流动力学指标。方法 回顾性分析2001年1月至2005年12月行脾切除、贲门周围血管离断术的90例门静脉高压症患者，断流术后FPP低于或等于30cmH2O者为低压组（34例），高于30cmH2O者为高压组（56例），比较两组术前肝功能情况，断流术前后不同时点的FPP变化和术后再出血发生率。结果 两组术前肝功能Child-Pugh计分（低压组6．6±1．1，高压组6．9±1．3，P=0．26）和FPP[低压组（37．9±2．5）cmH2O，高压组（38．9±2．9）cmH2O，P=0．09]之间的差异均无统计学意义，术后FPP[低压组（28．3±2．4）cmH2O高压组（34．0±3．3）cmH2jO，P〈0．01]和再出血率（低压组3％，高压组20％，P=0．02）之间的差异均有统计学意义。断流术中脾动脉结扎的降压效果最明显，断流术完成后较脾脏切除后FPP有所上升。结论 FPP是能够反映断流术减压效果和术后再出血风险的血流动力学指标，脾切除后FPP高于30cmH2O是断流术加行分流手术的依据之一。

Objective To investigate the relationship between postoperative portal pressure and rebleeding in patients with portal hypertension, and evaluate post-devascularization portal pressure as an indicator for the need of further portosystemic shunt. Methods Ninety patients who underwent devascularization from 2001 to 2005 were divided into low pressure group （ L group, postoperative free portal pressure FPP ≤ 30 cm H2O, n = 34） and high pressure group （ H group, FPP 〉 30 cm H2O, n = 56 ）. Preoperative hepatic function, intraoperative FPP and the morbidity of rebleeding were retrospectively compared with each other. Results There was no significant difference in preoperative Child-Pugh score （ L group： 6. 6 ± 1.1, H group： 6. 9 ± 1.3, P = 0. 26 ） and pre-devascularization FPP （ L group： 37.4± 2. 5 cm H2 O, H group： 38.9 ± 2. 9 cm H2 O, P = 0. 09） between the two groups, but the postoperative FPP （ L group： 28. 3 ± 2. 4 cm H2 O, H group： 34. 0 ± 3. 3 cm H2 O, P 〈 0. 01 ） and rebleeding rate （ L group： 3%, H group： 20%, P =0. 02） in high pressure group was significantly higher than those in low pressure group. Conclusion In cases of devascularization the postoperative portal pressure is a predictor for postoperative rebleeding, so additional shunt may be needed when the FPP after splenectomy is over 30 cm H2O.