远端脾静脉-肝动脉分流术治疗猪肝硬化门脉高压症

Distal splenic vein-hepatic artery shunt in hepatic cirrhosis swine with portal hypertension

目的观察小型猪肝硬化门脉高压症动物模型建立远端脾静脉一肝总动脉分流术（下称脾肝分流术）后降低胃脾区静脉压力的效果。方法对照组和实验组猪各15头分别建立脾肝分流术，对照组猪术后处死不饲养，实验组猪术后饲养30d处死。结果脾肝分流术后胃脾区静脉血人肝亚甲蓝肝脏染色良好。维持静脉血人肝的睥静脉压力对照组为（20．51±0．74）cm H2O（1cm H2O=0．098kPa），实验组为（23．09±1．36）cm H2O（P〈0．05）。脾肝分流术建立后静脉和动脉两端形成压力差，对照组为（7．17±1．02）cm H2O，实验组为（9．55±1．32）cm H2O（P〈0．05）。术后实验猪无肝坏死及肝性脑病发生，脾肿大消失，肝功能等生化代埘指标术后7d波动最大，14d逐渐恢复，30d恢复到成模时状态。结论压力差是维持静脉血入肝降低胃脾区静脉压力的原始动力。术后肝功能等生化代谢指标紊乱需要进一步治疗：

Objective To approach the effect of distal splenic vein-hepatic artery shunt （SVHA） in hepatic cirrhosis swine for lowering the venous pressure in the gastrosplenic area. Methods Two groups （control and cirrhosis） were randomly set up with 15 small-scale swine in each group, and SVHA was performed on each swine. The swine in control group were executed after SVHA, and those in cirrhosis group were fed for 30 days after SVHA prior to killing. Results （ 1 ） After SVHA, the venous blood flow from gastrosplenie area flowed smoothly into the liver, confirmed with methylene blue dye. The splenic venous pressure in eontrol group was （20.51 ±0.74） cm H20 （1 em H20=0.098 kPa）, and （23.09±1.36） cm H20 in cirrhosis group （ P 〈 0. 05 ） ; （2） The pressure difference between splenic vein and hepatic ar- tery after SVHA in control group was （7. 17 ± 1.02） cm H20, and （9. 55 ± 1.32） em H20 in cirrhosis group （ P 〈 0. 05 ） ; （ 3 ） All swine in cirrhosis group survived well, and had no hepatic encephalopathy. Conclusion （ 1 ） The pressure difference between splenic vein and hepatic artery after SVHA is the origi- nal motivation for lowering the venous pressure in the gastrosplenie area and keeping the venous blood flowed smoothly into the liver; （2） Additional treatment after SVHA is needed for abnormal liver function.