壁内外双重断流术对门脉高压症患者近远期肝功能影响

The effects of double devascularization procedure in- and outside wall on short- and long-term hepatic function of portal hypertensive patients

目的观察壁内外双重断流术对门静脉高压症患者近远期肝功能的影响。方法回顾性分析笔者所在医院1989-01～2008-01收治的367例行壁内外双重断流术的门静脉高压症患者门静脉血流变化及术后肝功能的相关资料。结果断流前测自由门静脉压平均为(36.2±4.2)cmH2O(1cmH2O=0.098kPa),断流后压力为(31.4±3.3)cmH2O,有统计学差异(P<0.05)。断流手术后门静脉血流速度和血流量较术前显著降低,肝动脉血流速度和血流量较术前显著升高(P<0.05)。术后1、3个月肝功能较术前无明显改变(P>0.05),术后6、12个月肝功能较术前明显改善(P<0.05)。结论壁内外双重断流术能适度降低门静脉压力,同时强化肝动脉灌注,对维持患者术后近期肝功能、改善术后远期肝功能具有重要作用,因此该术式是一种合理有效的手术方式。

Objective To investigate the effects of double devascularization procedure in-and outside wall on short-and long-term hepatic function of portal hypertensive patients.Methods A retrospective clinical analysis about portal venous flow and short-and long-term hepatic function was made in 367 cases of portal hypertensive patients,who had admitted to authors＇ hospital and were subjected to double devascularization from January 1989 to January 2008.Results FPP（free portal vein pressure） was decreased from（36.2±4.2） cmH2O preoperatively to（31.4±3.3） cmH2O postoperatively（P0.05）.Compared with the preoperative liver function,the postoperative liver function had no significant changes later 1 and 3 months after operation（P0.05）,but improved significantly later 6 and 12 months（P0.05）.Conclusion The double devascularization procedure can not only decrease portal vein pressure moderately but also strengthen the hepatic artery perfusion.It plays an important role on maintaining short-term liver function and improving long-term liver function postoperatively.Therefore it is a reasonable and effective surgical procedure.