不同门奇断流术式对门静脉高压症犬血流动力学的影响

The effect of different procedures with paraesophagastric devascularlzation on hemodynamics of the portal venous system in canines with portal hypertension

目的观察不同门奇断流术式对肝硬化门静脉高压症犬血流动力学的影响。方法将肝硬化门静脉高压症模型犬32只，随机分为A（传统断流）组、B（选择性断流）组、C（吻合器断流）组及D（对照）组。于术前1周、术后1、6月测定各组犬的门静脉直径（PVD）、门静脉流速（PVV）和门静脉血流量（PVF），于术中、术后1、6月测定各组犬的自由门静脉压力（FPP）。结果术后1月A、B、C组的PVD、PVV、PVF均较术前明显降低（P〈0．05），其中A组各项指标（0．54±0．03）cm、（11．45±1．27）cm／min、（160．82±30．85）ml／min显著高于B（0．45±0．01）cm、（8．71±0．48）cm／min、（83．37±9．39）ml／min及C组（0．49±0．02）cm、9．85±0．39）cm／min、（111．21±12．68）ml／min（P〈0．05），C组显著高于B组（P〈0．05）。各组术后6月各指标与术后1月比较，差异无统计学意义（P〉0．05）。D组手术前后差异无统计学意义（P〉0．05）。A、B、C组手术后FPP均明显下降（P〈0．05），其中A组（2．05±0.07）kPa显著高于B组（1．28±0．05）kPa、C组（1．41±0．04）kPa，C组显著高于B组（P〈0．05）。术后1、6个月，A、B、C组FPP与手术后比较，差异无统计学意义（P〉0．05）。D组手术前、手术后、术后1、6个月比较，差异均无统计学意义（P〉0．05）。结论肝硬化门静脉高压症犬在行传统断流术、选择性断流术和吻合器断流术术后6个月内PVD、PVV、PVF和FPP均显著下降，其中传统断流术影响最小，选择性贲门周围血管离断术最大。

Objective To observe the effect of different procedures with paraesophagastric devascularization on hemodynamics of the portal venous system in canines of portal hypertension with liver cirrhosis. Methods Thirty-two portal hypertensive model canines were divided into 4 groups randomly ： group A, traditional paraesophagastric devascularization; group B, selective paraesophagastric devascularization; group C, paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with stapler; group D, control group. The portal venous diameter （PVD）, portal venous velocity （PVV） and portal venous flow （PVF） were determined one week before operation, and one month and 6 months after the operation. Free portal pressure （FPP） was measured peri-operation, and one month and 6 months after the operation. Results One and 6 month（s） after the operation, PVD, PVV and PVF in groups A, B and C were decreased as compared with those pre-operation （ P 〈 0.05 ）. The indices in group A [ （ 0.54 ± 0.03） cm, （ 11.45 ± 1.27） cm/s and （ 160.82 ± 30.85 ） ml/s, respectively ] were significantly higher than those in groups B [ （0.45±0.01） cm,（8.71 ±0.48） cm/s and （83.37±9.39） ml/s,respectively] and C [ （0.49± 0.02） cm, （9.85 ± 0.39） cm/s and （ 111.21 ± 12.68） ml/s, respectively ] （ P 〈 0.05）. The indices in group C were higher than those in group B （ P 〈 0. 05 ）. There was no significant differences in every group between one and 6 month（s） after the operation （P 〉0.05）. There was no significant difference in group D before and after operation （ P 〉 0.05 ）. FPP in groups A, B and C was decreased significantly as compared with that pre-operation （ P 〈 0.05 ）. FPP in group A [ （ 2.05 ± 0.07 ） kPa] was much higher than that in groups B [ （1.28 ±0.05） kPa] and C [ （1.41 ±0.04） kPa] （P 〈 0.05 ） , and that in group C was higher than in group B （ P 〈 0.05 ）. There was no significant difference in FPP in groups A,B and C in direct post-operation,one month and 6 month（s） after operation （ P 〉 0.05 ）There was no significant difference in FPP of group D before and after operation （ P 〉 0.05 ）. Conclusion PVD, PVV, PVF and FPP were decreased significantly after traditional paraesophagastric devascularization,selective paraesophagastric devascularization and paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with stapler in portal hypertensive canines with hepatic cirrhosis within 6 months. Among these three devascularization procedures, traditional paraesophagastric devascularization has the slightest effect and selective paraesophagastric devascularization has the largest effect on hemodynamics of portal venous system.