术中肝动脉栓塞化疗对门静脉压力的影响

The effects of hepatic arterial chemoembolization on the portal vein pressure in patients with hepatocellular carcinoma

目的 探讨术中肝动脉栓塞化疗 (hepaticarterialchemoembolization,HACE)对自由门静脉压力 (freeportalpressure,FPP)的影响。 方法 10例不能切除肝癌患者 ,术中分别经胃网膜右动静脉插管至肝动脉及门静脉主干 ,并将埋植式给药装置 (implantabledrugdeliverysystem ,IDDS)植于腹壁皮下 ,将超液态碘油 10ml与阿霉素 4 0mg、顺铂 4 0mg、氟脲嘧啶脱氧核苷 15 0 0mg充分乳化并注入肝动脉 ,经IDDS测定栓塞前后及术后 1、3、5、7、14、2 1、2 8d之FPP。结果 10例患者HACE术后FPP均明显升高 ,术后 3～ 7d达高峰 ,之后逐渐缓慢下降 ,但始终高于初始水平 ,4例术后FPP≥ 3 5cmH2 O(1cmH2 O =0 .0 98kPa)者 ,3例并发上消化道出血 ,而 6例FPP <3 5cmH2 O者均未发生上消化道出血。结论 HACE可致FPP升高 ,FPP升高与HACE术后上消化道出血密切相关。

Objective\ To study the effects of hepatic arterial chemoembolization (HACE) on free portal pressure (FPP) in patients with hepatocellular carcinoma (HCC).Methods\ The FPP before and after HACE and 1、3、5、7、14、21、28 days after operation was directly and dynamically measured through implantable drug delivery system (IDDS) which were inserted into portal vein and implanted under the skin of abdominal wall intraoperation in 10 patients with HCC. Results\ FPP had an obvious increase after HACE in 10 cases. The absence of cirrhosis, the tumor thrombus in portal vein and extent of HACE were significantly correlated with the amplitude of the FPP elevation. Three out of 4 patients with FPP more than 35 cm H 20 after operation were associated with upper gastrointestinal bleeding. Conclusion\ The HACE would led to a reversible increase of FPP, which was the important factors for postoperative gastrointestinal bleeding.