再改良Sugiura术对肝硬化门静脉高压症患者门静脉血流动力学及肝功能的影响

Impact of the re-modified Sugiura procedure on portal hemodynamics and liver function in cirrhotic patients with portal hypertension

目的评价再改良Sugiura术对肝硬化患者门静脉血流动力学和肝功能的影响。方法收集2006年6月至2014年10月宜昌市第二人民医院47例肝硬化门静脉高压症患者资料。47例均行再改良Sugiura术治疗，分析手术前后自由门静脉压（FPP）、门静脉血流量（PVF）及肝功能的变化。结果最终纳入40例患者。（1）开腹后、切脾后及断流后FPP分别为（43．2±1．8）cmH2O、（34．8±1．6）cmH2O、（35．2±1．7）cmH2O；FPP（切脾后）比FPP（开腹后）、FPP（断流后）比FPP（开腹后）均降低（P〈0．05）；FPP（断流后）比FPP（切脾后）无变化（P〉0．05）；（2）彩色多普勒超声测定术前1天、术后10天、术后6个月、术后18个月PVF分别为（1420．4±137．7）ml／min、（1205．2±126．7）ml／min、（875．8±118．0）ml／min、（893．8±114．7）ml／min；PVF（术后10天）比PVF（术前1天）、PVF（术后6个月）比PVF（术后10天）、PVF（术后18个月）比PVF（术前1天）均降低（P〈0．05）；PVF（术后18个月）比PVF（术后6个月）无变化（P〉0．05）；（3）术前1天、术后10天、术后6个月、术后18个月肝功能ChildA级率各时段比较均无变化（P〉0．05）。结论再改良Sugiura术能持久、适当、有效地降低PVF和FPP，对肝硬化患者肝功能无负面影响。

Objective To evaluate the impact of the re-modified Sugiura procedure on portal hemodynamics and liver function in cirrhotic patients with portal hypertension. Methods Forty patients with cirrhosis and portal hypertension who underwent the re-modified Sugiura procedure in the Yichang Second People＇s Hospital from June 2006 to October 2014 were studied. Changes in the free portal pressure （FPP） , portal venous flow （PVF） and liver functions before and after operation were analyzed. Results （ 1 ） The FPP at different phases of the operation （ after opening the abdomen, after spleneetomy, and after devascu- larization） were （43.2 ± 1.8） cmH2O, （34.8 ± 1.6） cmH2O and （35.2 ± 1.7） cmH2O, respectively. There were significant differences in FPP between the phases of after splenectomy and after opening the abdomen, as well as after devascularization and after opening the abdomen （ P 〈 0.05 ）. There was no significant difference in FPP between after devascularization and after splenectomy （ P 〉 0.05 ）. （2） The PVF, which were measured with Doppler sonography at 4 time points （ preoperative 1 day, postoperative 10 days, postoperative 6 months, postoperative 18 months）, were （ 1 420.4 ± 137.7） ml/min, （ 1 205.2 ± 126.7） ml/min, （875.8 ± 118.0） ml/min and （893.8 ± 114.7） ml/min, respectively. There were significant differences in PVF between postoperative 10 days and preoperative 1 day, between postoperative 6 months and postoperative 10 days, as well as between postoperative 18 months and preoperative 1 day （P 〈0.05）. There was no significant difference in PVF between postoperative 18 months and postoperative 6 months （ P 〉 0.05 ）. （ 3 ） The liver functions were evaluated using the Child-Pugh score at 4 time points （ preoperative 1 day, postoperative 10 days, postoperative 6 months, postoperative 18 months）. There were no significant differences a- mong the time points, （ P 〉 0.05 ）. Conclusion The re-modified Sugiura＇s procedure durably, appropriately and effectively reduced the PVF and FPP, patients with cirrhosis.