肝硬化门脉高压胃左静脉血液流向与流速变化

Direction and velocity of blood flow in left gastric vein in portal hypertensives

目的：旨在探讨胃左静脉（LGV）血液的流速和流向变化与肝硬化门脉高压食管静脉曲张发生、发展及转归的关系．材料与方法：对30例健康对照者和200例肝硬化病人，应用复型脉冲多普勒流速计进行了B型和多普勒超声显像检查．结果：（1）LGV血流方向全部健康对照者为向肝型，相反，肝硬化病人83％（165／200）血流方向是高肝型；（2）LGV血流速度健康对照者为7．6±2．5cm／s，肝硬化病人血流呈向肝型时流速为78±2.1cm／s，而血流呈高肝型时为123±2.5cm／s。随着静脉曲张程度增大，离肝血流速度平行增加.（3）门脉压力LGV呈离肝型血流的病人（2.45±0.33kPa）显著高于向肝型血流者（1．89±0.22kPa）（P＜0．01）。（4）口服葡萄糖后，35例向肝型血流的门脉高压病人中，有21例其LGV血流方向转变为离肝血流。86％（43／50）食管静脉曲张病人，在葡萄糖摄入后其离肝血流速度显著加快，而对照者无变化。结论：门脉高压病人LGV离肝血流速度过快、使食管静脉曲张具有出血的高度危险性。

Objective: This study was to elucidate the direction and velocity of blood flow in the left gastric vein (LGV) in relation to the development and fate of esophageal varices in cirrhotic patinets. Methods: The direction and velocity of the LGV was examined by duplex-type pulsed Doppler ultrasonography in 30 healthy controls and 200 cirrhotic patients. Results: (1)Flow direction in the LGV was hepatopetal in all healthy controls, but was hepatofugal in 83% (165/200)of cirrhotic patients. (2) velocity of in LGV in healthy controls was 7.6±2.5cm/s, in cirrhotic patients it was 7.8±2.1cm/s when the flow was hepatopetal and 12.3±2.5cm/s when hepatofugal.Hepatofugal flow velocity is parallelily increased with development of esophageal varices. (3) Portal pressure in patients with hepatofugal flow (1.89±0.22kPa) (P<0.01). (4) LGV blood flow after oral glucose turned to hepatofugal in 21/35 patients. A significant increase in The velocity of hepatofugal now was observed in 86%. patients with esophageal varice but practically none occurred in the controls. Conclusions: High velocity blood flow in LGV in patients with esophageal varices carries with it a high risk of bleeding.