肝癌不同治疗方法对门静脉压力的影响

Effects of different treatment on the portal vein pressure in patients with liver cancer

目的 :观察肝癌不同治疗方法对门静脉压力 (FPP )的影响 ,并探讨 FPP变化与肝癌术后早期上消化道出血之间的联系。方法 :10 8例肝癌患者 ,分别行肝切除 (n=74)、肝动脉栓塞化疗 (n=11)、肝动脉结扎 (n=3)、肝动脉门静脉插管 (n=14)、肿瘤内无水酒精注射 (n=6 )及术后肝动脉门静脉化疗 (n=2 2 ) ,术中经胃网膜右静脉插管至门静脉主干 ,并将埋植式给药装置 (IDDS)植于腹壁皮下 ,经 IDDS分别测量治疗前、治疗后及术后 1、3、5、7、14、2 1、2 8天之 FPP。结果 :除肝动脉门静脉插管及肿瘤内无水酒精注射外 ,其余各种治疗方法术后 FPP均出现一过性升高 ,以术后 1～ 7天升高最为显著 ,之后逐渐缓慢下降 ;2 4例 FPP≥35 cm H2 O者 ,16例并发术后早期上消化道出血 ,而 FPP<35 cm H2 O的全部病例均未发生出血。结论 :肝切除、肝动脉栓塞化疗等主要治疗方法将造成 FPP升高 ,FPP的升高与术后早期上消化道出血之间存在密切联系 ,动态监测

Objective:To observe the effects of different treatment on free portal pressure (FPP) in patients with liver Cancer, and to explore the relations between FPP level and early postoperative upper gastrointestinal bleeding.Methods: FPP before and after hepatectomy(n=74), hepatic arterial chemoembolization(n=11), hepatic artery ligation(n=3), hepatic artery and portal vein intubatton(n=14), alcohol injection(n=6), hepatic artery and portal vein chemotherapy after operation(n=22) and 1,3,5,7,14,21,28days after treatment was directly and dynamically measured through implantable drug delivery system(IDDS) which was inserted into portal vein and implanted under the skin of abdominal wall intraoperation in 108 cases patients with liver cancer.Results:FPP had a reversible increase after all different treatments except hepatic artery and portal vein intubatton and alcohol injection. Sixteen out of 24 patients with FPP≥35cmH 2O after treatment were associated with upper gastriointestinal bleeding.Conclusion:The majority of treatment in patients with liver cancer would lead to a reversible increase of FPP. There was a close relationship between the increase of FPP and early postoperative upper gastrointestinal bleeding. Dynamic monitoring of FPP can predict the occurrence of upper gastrointestinal bleeding and is therefore helpful in its prevention and treatment.