选择性脾胃区减断分流术对肝脾血流动力学的影响

Effects of selective shunt pins devascularization on splanchnic hemodynamics

目的探讨肝硬化门静脉高压患者行选择性脾胃区减断分流术（SDDS—GSR）后肝脾血流动力学的改变及临床意义。方法前瞻性收集41例行SDDS—GSR术治疗患者的超声检查资料，按术前、术后2周及术后1年分为3期，并以21例正常体检患者为对照进行研究。结果（1）脾脏厚度在术后2周（47±8）mm及术后1年（46±8）mm较术前（60±9）mm显著减小（P〈0．01）。（2）术后2周门静脉直径（1．13±0．19）cm较术前显著变窄（P〈0．01），脾动脉直径（0．49±0．08）cm较术前显著变窄（P〈0．05），肝动脉直径（0．40±0．07）am较术前显著增宽（P〈0．05）。术后1年门静脉直径（0．89±0．17）cm均较术前显著变窄（P〈0．01）。（3）术后2周门静脉血流量（649±294）ml／min和脾动脉血流量（446±254）ml／min较术前显著减小（P〈0．01），肝动脉缸流量（612±295）ml/min较术前湿著增加（P〈0．01）。术后1年肝动脉血流量（401±152）ml/min与术前和正常组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患者肝脾血流动力学参数发牛异常变化；SDDS—GSR有助于纠正肝硬化门静脉高压症患者肝脾血流动力学的紊乱状态。

Objective To evaluate the changes of splanehnie hemodynamics after selective deeongestive devascularization shunt of gastrosplenic region （SDDS-GSR） in the treatment of patients with portal hypertension. Methods All these 41 portal hypertensive patients underwent a combination surgery including partially occlusion of the splenic artery＇, Warren distal splenorenal shunt and devascularization. Postoperative patients were followed-up by uhrasonography for changes of splanchnic hemodynamies. Results were compared with that of 21 healthy volunteers. Results The thickness of spleen 2 weeks and 1 year after surgery （47±28） mm, （46±28） mm decreased from preoperative （60±29） mm （P 〈0.01 ）. The diameter of portal vein （ 1.13± 0. 19 ） em and splenic artery （ 0.49± 0. 08 ）cm 2 weeks after surgery deereased （P 〈 0.05 ） and that of hepatic artery （0. 40± 0. 07 ）em increased （ P 〈 0. 05 ）. Patients＇ preoperative portal vein blood flow volume （1716 ± 1262） ml/min and splenic artery （1269± 570） ml/min were larger than that of normal group （P 〈 0. 05 ）, while that of hepatic artery （321 ± 126） ml/min was significantly less than that of normal group （ P 〈 0. 05 ）. The portal blood flow （ 649 ± 294 ） ml/min and that of splenie artery, （446 ±254） ml/min 2 weeks after surgery deereased significantly （P 〈0. 01 ）. The hepatic artery blood flow （612 ± 295） ml/min increased signifieantly （P 〈 0.01 ）. When reevaluated at 1 year the hepatic artery blood flow （401± 152） ml/min was not significantly different compared with that before surgery and that in normal group （ P 〉 0. 05 ）. Conclusions There are significant alterations in hepatic and splenic hemodynamics in patients with portal hypertension, and that SDDS-GSR can partially reverse the chaos of the hepatic and splenic hemodynamics in cirrhotic portal hypertensive patients.