肝硬化食道静脉曲张的门脉血流动力学改变及相关参数的研究分析

Hemodynamics of portal vein in cirrhotic patients with esophageal varices

目的通过探讨乙肝肝硬化食道静脉曲张患者的门脉血流动力学改变,遴选敏感预测食道静脉曲张程度的相关彩色多普勒指标。方法肝硬化组80例,对照组30例,均经内镜检查,将食道静脉曲张程度分为轻、中、重度。彩色多普勒超声(CDFI)测定门静脉主干(PV)、脾静脉(SV)、肠系膜上静脉(SMV)及胃左静脉(LGV)四条静脉血管内径(D,cm)、平均血流速度(V,cm/min),血流量(Q,ml/min)。结果 1.肝硬化组VPV、VSV、VSMV较对照组明显减低、VLGV的流速较对照组明显增快,DPV、DSV、DSMV、DLGV较对照组增宽,Qsv、Qpv、QLGV、QSMV均较对照组明显增多,肝硬化组Qsv/Qpv为54.5%,高于对照组的30.3%。2.随食道静脉曲张程度的加重,DPV逐渐增加、VPV逐渐下降、DLGV、VLGV、QLGV均明显增加,重度组均可见"红色征",其中(++)者为92.3%(36/39)。3.对照组LGV血流均呈向肝型,在肝硬化组中可见向肝、离肝、双向三种血流方向,肝硬化组中81.25%为离肝型血流,5%为双向型血流,13.75%为向肝型血流,其中重度组的离肝型血流比例高达94.9%。结论肝硬化门脉高压时PV、SV、SMV及LGV的血流动力学均有明显的改变,可作为判断食道静脉曲张程度的敏感、无创性诊断指标,其中LGV血流动力学指标在判断重度食道静脉曲张方面具有更重要的临床价值。

Objective To study the changes of portal system hemodynamics and its relationship with degree of esophageal varices by color Doppler ultrasonography in cirrhotic patients. Methods 80 cirrhotic patients were divided into mild,moderate and severe groups according to the degree of esophageal varices. 30 healthy controls were included in the study. The blood flow hemodynamics including diameter （D）,blood flow velocity （V）,and the blood flow volume （Q） of portal vein （PV）,splenic vein （SV）,superior mesenteric vein （SMV） and left gastric vein （LGV） were measured by CDFI. Results The blood flow velocity of PV,SV and SMV was much lower whereas the blood flow velocity of LGV was much higher,and the diameter of PV,SV,LGV and SMV was much wider in cirrhotic patients than the healthy controls. The ratio of the patients QSV/QPV was 54.5%,which was higher than 30.3% of the control group. With the increasing degrees of esophageal varices the DPV was wider,the VPV was slower,and the DLGV,VLGV and QLGV were significantly increased. Red symptom was found in all severe group patients and in about 92.3% （36/39）of degree-2 group. Flow direction of LGV in the cirrhotic patients was hepatopetal in 81.25%,to-and-fro state in 5.0%,hepatofugal in 13.75% and hepatopetal in the healthy control group Flow direction was hepatofugal for 94.9% patients in the severe group. Conclusion The PV,SV,SMV and LGV indexes were highly sensitive and specific parameters for the diagnosis of the degree of esophageal varices by Doppler ultrasound. Therefore,the hemodynamics analysis by Doppler ultrasound may serve as the noninvasive parameter for early diagnosis of esophageal varices.