介入性门脉断流术对门静脉血流动力学的影响

Effects of portal-vein operation flow through intervention on hemodynamic.

目的探讨经皮胃冠状静脉栓塞联合脾部分栓塞术对门静脉血流动力学的影响。方法对54例临床明确诊断的肝硬化门脉高压症患者行胃冠状静脉栓塞并联合脾部分栓塞术治疗,门静脉插管直接测量介入术前、后自由门静脉压(FPP);通过彩超、增强CT扫描比较介入术前、术后门静脉(PV)及脾静脉(SV)的血流动力学指标。结果胃冠状静脉栓塞术后FPP较术前明显升高(P<0.01),联合部分脾栓塞术后复测,FPP有所降低,但术前、术后比较,差异无统计学意义(P>0.05);介入术后3个月,门静脉内径、血流量及血流速度较术前变化不大,而脾静脉内径缩小较明显(P<0.05),血流速度及血流量显著降低(P<0.01)。结论胃冠状静脉栓塞术会引起门静脉压力升高,但联合脾部分栓塞术并不影响门静脉血流动力学变化。

Objective To explore the effect of percutaneous transhepatic gastric variceal embolization joint partial splenic embolization on hemodynamic of portal vein. Methods 54 cases who were clinically diagnosed as cirrhosis with portal hyperten- sion, were treated with pereutaneous transhepatic gastric variceal embolization combined with partial splenic embolization. The pre- operative and postoperative free portal vein pressure （FPP） were measured by portal vein intubation, and the preoperative and post- operative portal vein （PV）,spleen vein （SV） in hemodynamic changes were compared through color dopplar ultrasound and CT scan scanning. Results FPP were significantly increased after percutaneous transhepatic gastric variceal embolization （P 〈 0. 01 ） , and reduced after partial splenic embolization（ P 〉 0. 05 ）. After 3 months , portal venous blood flow and inner diameter and blood flow velocity only was a little change, but spleen vein inner diameter, blood flow velocity and blood flow were decreased sig- nificantly（P 〈 0.01 ）. Conclusion Percutaneous coronary arteriovenous embolization could increase FPP, and it eouldn＇ t effect the change of portal venous blood flow dynamics only combed with partial splenic embolization .