附加限制环的限制性门腔静脉侧侧分流加肝动脉强化灌注术的临床研究

A clinical study on side-to-side portacaval shunt plus enhancement of perfusion of hepatic artery

目的 在实验研究证实其有效性的基础上 ,我们设计实施了附加限制环的限制性门腔侧侧分流加肝动脉强化灌注术的临床研究 ,以期改善门腔分流术后肝供血。方法 观察病例随机分为两组 :附加限制环的限制性门腔侧侧分流加肝动脉强化灌注术组 (简称 :强化组 )和附加限制环的限制性门腔侧侧分流术组 (简称 :分流组 ) ;采用不同术式分别观察其术后近期效果。结果 强化组较分流组 :术后近期 ,肝功能指标无明显改善 ;核素动态肝胆显像 :通过强化肝动脉血流明显增加 ,因而对肝功能有一定的保护作用。结论 此术式通过强化肝动脉灌注 ,相对减少分流术造成的肝血供下降 ;相对增加肝营养因子的供给 ,对肝功能有一定维护作用 ,减轻术后肝纤维化程度 ;一定程度上克服了门腔分流术或断流术的不足 ,有望成为治疗门静脉高压症的新的实用术式。

Objective To study the effect of portacaval shunt (PCS) plus enhancement of perfusion of hepatic artery (EPHA). Methods The admitted patients were randomized into two groups: PCS group and PCS+EPHA group. The two different operations were performed and their early effects observed. Results In the early stage after operation, the flow of hepatic artery was significantly enhanced and the indexes of hepatic function were better in PCS+EPHA group than in PCS group. Conclusions PCS+EPHA can increase the perfusion of hepatic artery, maintain the liver function, delay the cirrhotic course of the liver and overcome the side effects of PCS. Meanwhile, it has the advantage of shunt and devascularization. It can be a new useful surgical technique in treatment of portal hypertension.