门静脉高压症断流术后食管胃底静脉曲张及门静脉血流动力学的变化

Changes of esophagogastric varicosis and portal hemodynamics in cirrhotic portal hypertensive patients after Hassab procedures

目的 观察肝炎后肝硬化门静脉高压症断流术前后食管胃底静脉曲张及门静脉血流动力学的改变.方法 在胃镜下观察肝炎后肝硬化门静脉高压症Hassab手术前后161例患者食管胃底静脉曲张情况,用彩色多普勒检测手术前后不同时期门静脉血流动力学的改变.结果 术后6、12、18个月内轻度食管静脉曲张比例分别为44.1%、34.7%、28.4%,较术前（7.5%）升高（P＜0.05） 重度食管静脉曲张比例6、12、18个月分别为25.1%、30.0%、35.0%,较术前（65.2%）降低（P＜0.05） 轻度食管静脉曲张伴胃底静脉曲张术前为16.6%、术后6、12、18、24个月分别为7.4%、9.2%、9.1%、10.3%,重度食管静脉曲张伴胃底静脉曲张术前为43.8%、术后6、12、18、24个月分别为45.8%、45.2%、47.4%、48.8%,两者相比差异均有统计学意义（P＜0.05）.术后6、12个月内门静脉主干、门静脉右支内径分别为（10.5±2.2）mm、（11.2±1.2）mm、（8.1±1.3）mm、（8.2±2.2）mm,与术前（13.5±1.7）mm、（9.8±2.0）mm相比变小（P＜0.05） 术后6、12个月门静脉主干最大血流速度和门静脉左支平均血流速度分别为（11.5±1.6）cm/s、（11.8±1.8）cm/s、（11.0±1.9）cm/s、（11.1±1.9）cm/s,分别较术前（13.6±2.6）cm/s、（13.3±2.6）cm/s减慢（P＜0.05） 门静脉主干血流量术后6、12个月分别为（847±249）ml/min和（907±310）ml/min,分别较术前（1095±290）ml/min减少（P＜0.05） 门静脉右支平均血流速度在术后6个月时为（11.6±2.6）cm/s,较术前（13.2±2.9）cm/s减慢（P＜0.05）.结论 Hassab断流术后18个月内食管静脉曲张程度减轻,18个月后食管静脉曲张程度逐渐增加,而且随食管静脉曲张程度增加胃底静脉曲张发生率增高.Hassab术后12个月内门静脉血流速度减慢、血流量减少、门静脉内径缩小.

Objective To investigate changes of esophagogastric varicosis,and portal hemodynamics in cirrhotic portal hypertensive patients after Hassab surgical operation. Method The changes of esophageal varicosis and gastric varices incidences at different phases of cirrhotic patients after the Hassab surgical operation were examined by electric endoscope.Hemodynamics of portal vein system was measured by Doppler color imaging and color Doppler ultrasound after operation. Results Mild esophageal varicosis incidences on the 6th,12th and 18th month after the Hassab surgical operation were respectively 44.1%,34.7% and 28.4%,higher than that before operation （7.5%） （P〈0.05）.Severe esophageal varicosis incidences on the 6th,12th and 18th month were respectively 25.1%,30.0% and 35.0%,lower than that before operation （65.2%） （P 〈 0.05）.Mild esophageal varicosis with gastric varices incidences on the 6th,12th,18th and 24th month before and after operation were respectively 16.6%,and 7.4%,9.2%,9.1%,10.3% respectively.Severe esophageal varicosis with gastric varices incidences in the 6th,12th,18th and 24th month were respectively 43.8%,and 45.8%,45.2%,47.4%,48.8% （P〈0.05）.Inner diameter of portal vein and the right branch of portal vein on the 6th and 12th month before and after operation were respectively （13.5±1.7） mm,（9.8±2.0） mm,（10.5±2.2） mm,（11.2±1.2） mm,（8.1 ± 1.3） mm and （8.2 ± 2.2） mm （P 〈 0.05）.Maximum flow rate and blood flow of portal vein,velocity of the left of portal vein in the 6th and 12th month were respectively （13.6 ±2.6） cm/s,（1095 ±290） ml/min,（13.3±2.6） cm/s,（11.5 ±1.6） cm/s,（11.8 ±1.8） cm/s,（847 ±249） ml/min,（907 ± 310） ml/min,（11.0 ± 1.9） cm/s and 11.1 ± 1.9 cm/s （P 〈 0.05）.Velocity of the right of portal vein in the sixth month were （11.6 ± 2.6） cm/s,which was significantly slower than preoperative level of （13.2 ± 2.9） cm/s. Conclusion After the Hassab surgical operation the degree of esophageal varices lightens during 18 months and aggravates after 18 months.There is obvious relation between gastric varices and the degree of esophageal varices.Velocity of portal blood flow becomes slow,blood flow diminishes and inner diameter reduces after the Hassab surgical operation.