胃底静脉栓塞及脾动脉栓塞对门脉血流动力学的影响

Influence of percutaneous transhepatic fundus vein embolism and splenic arterial embolism on portal hemodynamics in hepatocirrhosis

目的探讨胃底静脉栓塞（PTVE）及部分脾动脉栓塞（PSE）对门脉血流动力学的影响。方法对43例门脉高压患者行PTVE及PSE，在盯VE前、后及PTVE＋PSE后分别测自由门脉压力（FPP）；同时运用彩色多普勒血管超声技术探测门静脉（PV）、脾静脉（SV）内径和最大血流速度，并计算各静脉的平均流速、血流量。结果PTVE后FPP有不同程度的升高（P〉0．05）。PTVE＋PSE后FPP明显下降（P〈0．05）。PV、SV直径明显缩小、血流速度显著改善（P〈0．05）。结论联合盯VE及PSE在快速有效的降低门脉压力的同时并不影响门脉平均血流量。在显著改善食管静脉曲张的同时能较好的维持肝脏灌流，对相应症状的改善有重要意义。

Objective To study influence of percutaneous transhepatic fundus venous embolism （PTVE） and partial splenic embolism （PSE） on portal hemodynamics. Methods PTVE and PSE were performed on 43 patients with portal hypertension. Free portal pressure （FPP） was determined, respectively, before and after PTVE and after PTVE ＋ PSE. At the same time, color Doppler ultrasonic angiography was used to measure diameter and maximal blood flow vate of portal vein （PV） and splenic vein （SV）. Average rates of these venae were calculated and volumes of blood flow were estimated. Results FPP was respectively, before and after PTVE （ P 〉 0.05 ）. FPP was significantly different from that before operation （ P 〈 0.05）. A decrease of DV and SV diameter, flow volume was demonstrated （ P 〈 0.05 ）. Conclusion Combined application of percutaneous transhepatic fundus venous embolism with partial splenic arterious embolism may rapidly and effectively reduce portal pressure and has meanwhile no influence on average portal flow volume. While markedly improving varices of esophagus,it may maitain hepatic perfusion and function well, which is of importance in improving corresponding symptoms.