肝硬化门静脉高压症Hassab断流术后患者静脉曲张与血流动力学的变化

Changes of varicosis and hemodynamics in cirrhotic patients with portal vein hypertension after Hassab devascularization

目的 分析肝炎肝硬化门静脉高压症Hassab术后患者不同时期食管胃静脉曲张情况与门静脉血流动力学变化,评估患者预后.方法 对161例患者Hassab术前、术后6、12、18、24个月,内镜检查食管、胃底静脉曲张情况,彩色多普勒检测门静脉血流动力学变化,评价Child-Pugh肝功能分级情况.结果 术后6、12、18个月内轻度食管静脉曲张患者比例分别为44.0%、34.8%、28.3%,较术前（7.5%）增高（P＜0.05）,重度食管静脉曲张比例术后6、12、18个月内分别为25.2%、29.7%、34.9%,较术前（65.2%）降低（P＜0.05）;胃底静脉曲张发生率与食管静脉曲张程度相关.术后12个月内门静脉主干、门静脉右支内径较术前缩小（P＜0.05）,门静脉主干最大血流速度及血流量、门静脉左支平均血流速度减慢（P＜0.05）,门静脉右支平均血流速度在术后6个月时较术前减慢（P＜0.05）.术后6、12、18个月内Child-Pugh分级肝功A级患者比例分别为63.5%、60.6%、57.9%,较术前（4 8.4%）升高（P＜0.05）.但至术后24个月时,各项指标均接近于术前水平.结论 Hassab术后患者18个月内整体食管静脉曲张程度减轻,术后12个月内门静脉血流动力学降低,术后18个月内整体肝功能改善.

Objective To analyze the changes of varicosis and hemodynamics in cirrhotic patients with portal vein hypertension at different stages after Hassab devascularization, and to evaluate the outcome.Methods Hassab devascularization was performed in 161 patients with portal vein hypertension, who were all evaluated by means of endoscopy, Doppler color imaging and Child-Pugh grading before and 6, 12, 18,24 months after the procedure, respectively.Results The rates of mild esophageal varicosis were 44.0%,34.8% and 28.3% at 6, 12 and 18 months after Hassab devascularization, respectively, which were all significantly higher than that before the operation（7.5%, P 〈 0.05）, while the rates of severe esophageal varicosis were 25.2%, 29.7% and 34.9% at 6, 12 and 18 months after the procedure, which were significantly lower than that before（65.2%, P 〈 0.05）.The incidence of varices in gastric fundus was correlated with the severity of esophageal varices.At 12 months after the operation, the inner diameters of portal vein and its right branch significantly decreased when compared with those before（P 〈 0.05）, the maximal flow rate,volume of portal vein and average flow rate of the left branch also significantly decreased（P 〈 0.05）.At 6 months after the operation, the average flow rate of the right branch slowed down（P 〈 0.05）.Child-Pugh Grade A accounted for 63.5%, 60.6% and 57.9% at 6, 12 and 18 months after the operation, respectively, which were significantly higher than that before（48.4%, P 〈0.05）.When evaluated at 24 months after the procedure, all variables were getting close to those before.Conclusion The severity of esophageal varices mitigates in 18 months after Hassab.Hemodynamics of portal vein system decreases in 12 months.The overall liver function improves in 18 months after the operation.