猪门脉高压脾肝分流术后的血流动力学变化

Hemodynamic changes on animal models of portal hypertension after spleen and liver shunt

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-肝总动脉分流术（脾肝分流术）后门脉血流动力学变化及影响。方法15头动物模型建立脾肝分流术，肝外门脉分割成胃睥静脉区和肠系膜上下静脉区，各自独立不相通。实验猪术后饲养30d。结果（1）脾肝分流术后门脉主干压为（23．49±1．10）emH20（1cmH20=0．098kPa），术后30d为（21．53±1．26）cmH，O（P〉0．05）；脾静脉压为（35．45±2．88）cmH20，术后30d为（23．09±1．36）cmH20（P〈0．05）；压力差为（17．90±3．31）cmH20，术后30d为（9．55±1．32）cmH20（P〈0．05）。（2）胃脾区静脉血经脾肝分流通道入肝，脾静脉注射亚甲蓝肝染色良好。结论脾肝分流术后肝外门脉血流通道发生了变更，但门脉血流动力学整体没有受到影响，反而建立了一种新的平衡机制来维持血流动力学的稳定，压力差是维护这种新平衡机制的原动力。

Objective To observe portal hemodynamic changes in miniature pigs with liver cirrho- sis and portal hypertension after distal splenic vein-hepatic artery shunt （ spleen and liver shunL）. Methods Fifteen pre-buih miniature pigs with liver cirrhosis and portal hypertension received spleen and liver shunt. The portal vein district outside the liver was divided into two separated and no-connect areas： stom- ach-spleen area and mesenteric up and down area postoperatively. After feeding for 30 days, pigs were sub- jected to re-open operation to get relevant data. Results （ 1 ） After the spleen and liver shunt, portal vein pressure was （23.49 ± 1.10） cm H20 （ 1 cm H20 =0. 098 kPa） , and （21.53±1.26） cm H/O after 30 days （P〉0.05） ; splenic vein pressure was （35.45±2.88） cm H20, and （23.09 ±1.36） cm H20 after 30 days （P 〈0.05） ; portal vein-splenic vein pressure difference was （17.90 ± 3.31 ） cm H20, and （9. 55 ±1.32） cm H20 after 30 days （P 〈0.05） ; （2） Blood from stomach-spleen area flowed into the liver by the spleen and liver shunt, and the liver stained well after methylene blue was injected into the splenic vein. Conclusion Extrahepatic portal vein blood flow channel changed after the spleen and liver shunt, the overall portal hemodynamies was not affected, and a new balanced mechanism was established to maintain hemodynamic stability. The new balancing mechanism is maintained by the pressure difference as the driving force.