脾肾分流加贲门周围血管离断术对门静脉系统血流动力学的影响

Effects of splenorenal shunt and pericardiac devascularization on hemodynamics

对 2 4例门静脉高压症患者行脾肾分流 (SRS)加贲门周围血管离断术 (PCDV) ,采用彩色多普勒检测其手术前后的血流动力学指标 ,于术中测定其门静脉压力 ,并与 35例行脾切除加 PCDV(断流组 )及 10例行脾切除加近端脾肾分流术 (分流组 )患者进行比较。结果 SRS+ PCDV组术后门静脉血流量 (PVF)及自由门静脉压 (FPP)均介于断流组与分流组之间 ;FPP下降与 PVF减少呈正相关 (P<0 .0 0 5 )。门静脉系统血流指标于术后半年内有降低的趋势 ,半年后基本保持稳定。认为 SRS+ PCDV能适量降低门静脉血流和门静脉压 ;术后门静脉血流肝内灌注良好 。

By Doppler Color flow Imaging(DCFI),the portal hemodynamic changes of 24 patients with portal hypertension(PH)were evaluated before and after splenorenal shunt(SRS)and pericardiac devascularization(PCDV),and the direct portal pressure was measured during operation,and compared with those of 35 patients with pH subjected to PCDV only and 10 patients with pH subjected to SRS only Results showed that the postoperative PVF of SRS+pCDV group was between that of PCDV and SRS group,so did the postoperative FPP of SRS+PCDV group there was a positive correlation between the lowering rate of FPP and the decreasing rate of PVF in the SRS+PCDV group(P<0 005) After operation,the hemodynamic parameters continued lessening for 6 months After 6 months,all parameters remained relatively constant It can be concluded that SRS+PCDV could moderately reduce PVF and FPP The liver hold a good perfusion from portal vein and portal venous hyperamia ameliorated effectively after operation