超声检测乙型肝炎肝硬化门脉高压症患者脾脏切除后门静脉和肝固有动脉血流动力学变化的意义

Ultrasonographic detection of hemodynamic changes in the portal vein and proper hepatic artery in patients with portal hypertension due to hepatitis B cirrhosis

目的通过彩色超声检测乙型肝炎肝硬化门脉高压症患者脾脏切除后门静脉和肝固有动脉血流动力学变化情况.方法选择2015-06/2017-04在浙江省义乌市中心医院住院的70例乙型肝炎肝硬化患者作为研究对象,均需行脾脏切除术,分别在术前、术后1、4 wk采用彩色多普勒超声观察肝脏门静脉和固有动脉的内径变化、收缩期峰值流速、舒张末期流速、阻力指数等变化情况.结果术后患者门静脉内径、收缩期峰值流速、舒张末期流速和阻力指数均较术前下降(均P<0.05),且术后4 wk下降程度明显于术后1 wk(均P<0.05).术后患者肝固有动脉内径、收缩期峰值流速、舒张末期流速均较术前增加(均P<0.05),而阻力指数较术前下降(均P<0.05),且术后4 wk变化明显于术后1 wk(均P<0.05).结论彩色多普勒超声能实时、动态观察乙型肝炎肝硬化脾脏切除患者门静脉和肝固有动脉的内径变化和血流动力学变化,对评估临床疗效具有重要价值.

AIM To detect the hemodynamic changes in theportal vein and proper hepatic artery in patients with portal hypertension due to hepatitis B cirrhosis by color Doppler ultrasound.METHODS Seventy patients with portal hypertension due to hepatitis B cirrhosis who underwent splenectomy from June 2015 to April 2017 at the Central Hospital of Yiwu City were included. All patients underwent color Doppler ultrasound examinations before and 1and 4 wk after surgery to observe the changes in the inner diameter, peak systolic velocity,end-diastolic velocity, and resistance index of the portal vein and proper hepatic artery.RESULTS Postoperatively, the inner diameter, peak systolic velocity, end-diastolic velocity, and resistance index of the portal vein significantly decreased compared with preoperative values（P〈0.05 for all）, and the changes were more significant at postoperative 4 wk than at postoperative 1 wk（P〈0.05 for all）. The postoperative inner diameter, peak systolic velocity, and end-diastolic velocity of the proper hepatic artery significantly increased（P〈0.05 for all）, but resistance index significantly decreased（P〈0.05） compared with preoperative values, and the changes were more significant at postoperative 4 wk than at postoperative 1 wk（P〈0.05 for all）.CONCLUSION Color Doppler ultrasound allows for real-time,dynamic detection of hemodynamic changes in the portal vein and proper hepatic arteryin patients with portal hypertension due to hepatitis B cirrhosis.