门静脉血流动力学检测在肝脏疾病介入治疗疗效评估中的应用

Application of portal vein hemodynamic detection in the efficacy evaluation of patients with hepatic disease underwent intervention therapy

目的观察各种肝脏疾病患者介入治疗前后门静脉血流动力学的变化及疗效,评价门静脉血流动力学检测的重要性和必要性。方法 2005～2011年收治的因不同肝脏疾病行动脉内介入术(tansarterial embolization,TAE)的患者378例,对原发性肝癌患者行肝动脉栓塞治疗;对肝硬化合并门静脉高压、脾功能亢进的患者行保证恒定栓塞面积的部分性脾动脉栓塞治疗;对原发性肝癌合并门静脉瘤栓患者行脾动脉药物灌注治疗。分别于术前和术后4周进行门静脉血流动力学检测和Child分级,统计并计算出血率。结果①原发性肝癌患者:治疗后对照1组门静脉血流明显减少,Child分级明显较差,出血率明显增加,与对照2组比较,差异均有统计学意义(P<0.05)。②肝硬化合并门静脉高压、脾功能亢进患者:治疗后对照1组的门静脉血流明显降低(P<0.05),出血率明显下降,与对照2组比较差异有统计学意义(P<0.05);而肝功能与TAE前比较无明显变化。③原发性肝癌合并门静脉瘤栓患者:治疗后对照1组的门静脉血流量明显升高,出血率明显降低,与对照2组比较差异有统计学意义(P<0.05);而肝功能与TAE前比较无明显变化。结论门静脉血流动力学检测在肝脏疾病介入治疗疗效评估中起至关重要的作用,在临床工作中应给予高度重视。

Objective To observe the hemodynamic changes of portal vein and clinical efficacy after intervention therapy in patients with various hepatic diseases,and evaluate the importance and necessarity of portal vein hemodynamic detection. Methods 378 patients with various hepatic disease underwent transarterial embolization（TAE） from 2005 to 2011 were enrolled in the study,hepatic arterial embolization were performed in patients with primary hepatic cancer,partial splenic arterial embolization were performed in patients with liver cirrhosis complicated by portal hypertension and hypersplenism, splenic arterial infusion chemotherapy were performed in patients with primary hepatic cancer complicated by portal vein tumor thrombus.Portal vein hemodynamic changes and Child classification were performed before and 4 weeks after operation,meanwhile the bleeding rate was counted.Results ①Primary hepatic cancer patients：The portal vein blood flow decreased obviously in control 1group after treatment,Child classification was worse and bleeding rate increased,there was significant difference when compared with control 2 group（P0.05）.②Hepatic cirrhosis complicated by portal vein hypertension and hypersplenism：Portal vein blood flow decreased obviously in control 1 group after treatment（P0.05）,bleeding rat ed declined obviously,there was significant difference when compared with control 2 group（P0.05）,while no obvious change was found in liver function compared with what before TAE.③Primary hepatic cancer complicated by portal vein tumor thrombus：portal vein blood flow increased significantly in control 1 group after treatment,bleeding rate declined ob viously,there was significant difference when compared with control 2 group（P0.05）,but there was no obvious change in liver function compared with what before TAE.Conclusion Portal vein hemodynamic detection plays an very important role in efficacy evaluation on hepatopathy underwent intervention therapy,much attention should be payed on it in clinical practice.