用放射性核素显像方法测定分流和断流术前后门静脉压力及其临床价值

Evaluation of portal vein pressure by radionuclide imaging in cirrhotic patients undergoing portacaval shunt or pericardial devascularization

目的比较放射性核素显像测定分流、断流术前后门体分流指数和实测门静脉压力的变化 ,探讨其临床应用价值。方法应用放射性核素显像法测定 15例分流术和 2 0例断流术前后门静脉高压症患者的门静脉压力 (H/L PVP) ,并与术中和术后的实测门静脉压力 (PVP)相比较。结果本组 35例手术中实测PVP值为 (37± 4)cmH2 O ,与术前经H/L PVP公式推算值 (36± 4)cmH2 O非常接近 (r =0 81,P <0 0 1)。 15例行分流手术的患者手术前后H/L PVP变化不大 ,而分流术后实测得PVP(2 8± 3)cmH2 O则较分流前的 (37± 5 )cmH2 O显著降低 (P <0 0 5 ) ;2 0例行断流术的患者术后H/L PVP平均下降较多 ,但与术前相比差异无显著意义 (P >0 0 5 ) ,而断流术后测得PVP数据较分散(P >0 0 5 )。结论H/L PVP可以真实反映门静脉高压症患者术前的门静脉压力 。

ObjectiveTo evaluate the changes of portal vein pressure by (PVP) radionuclide imaging in cirrhotic patients undergoing portacaval shunt or esophageal transection-splenectomy.MethodThe radionuclide imaging was used to calculate portal pressure perioperatively in 15 shunt and 20 esophageal transection-splenectomy patients of portal hypertension.Results were compared with direct portal vein manometry.ResultPVP by manometry in portal hypertension patients 〔(37±4)?cm?H 2O〕 was very close to that calculated by preoperative imaging 〔(36±4)?cm?H 2O〕r=0.81,P<0.01.Not the postoperative pressure calculated by imaging in 15 shunt patietns nor that in 20 devascularization patients were correlated significantly with the changes of portal pressure by postoperative manometry.Conclusions Radionuclide imaging is valuable in the evaluation of portal vein pressure only in preoperative portal hypertension patients.