部分性脾栓塞术改变门脉血流动力学的定量研究

Clinical quantitative study of therapeutic effect of partial splenic embolization (PSE) on portal vein hemodynamics

目的 研究部分性脾栓塞术 (PSE)前、后门脉血流及压力的改变。方法 31例临床确诊肝硬化脾功能亢进的患者经股动脉穿刺行部分性脾栓塞术 ,术前及术后彩色多普勒超声 (简称彩超 )观测门静脉主干 (PV)、脾静脉主干 (SV)、肠系膜上静脉主干 (SMV)的血流改变情况 ,1 1例栓塞前后经皮经脾穿刺脾静脉分别置管于PV、SV、SMV测压。结果 31例患者PSE术后PV、SV及SMV血流量较术前明显减少 (P <0 0 5) ;PV、SV血流量减少程度与栓塞程度呈正相关 ,r值分别为 0 589、0 862 ,P值均 <0 0 1。 1 1例患者 (栓塞程度 60 %～ 80 % )栓塞前后测压结果表明栓塞后PV、SV、SMV的压力均较术前明显降低 (P <0 0 0 1 ) ;PV、SV、SMV的压力下降程度分别为 (2 2 2± 5 8) %、(2 8 5± 1 7) %、(1 9 5± 8 1 ) % ,且PV、SV压力降低程度与栓塞程度呈正相关 ,r值分别为 0 645、0 687,P值均 <0 0 5。结论 栓塞面积控制在 60 %～ 80 %可较好的改善肝硬化脾功能亢进患者的外周血象 ,减少门脉血流量和降低门脉压力 ,减轻食管。

Objective To research the changes of blood flow and pressure of the portal vein at both pre and post PSE. Methods The blood flows of the portal vein (PV), splenic vein (SV), and superior mesentery vein (SMV) were measured by using color Doppler in 31 cases with clinically proved hepatic cirrhosis and hypersplenism at both pre and post PSE. The pressure of the portal vein and its branches was measured by percutaneous and trans spleen portal venous catheterization, respectively both pre and post embolization in 11 cases of them. Results The blood flow of PV, SV, and SMV decreased significantly in all 31 cases after PSE ( P < 0 05). The decreased degrees of blood flow of both PV and SV after PSE were positively related to the embolization degree ( r =0 589, P =0 002 for PV; r =0 862, P <0 001 for SV). In 11 cases whose embolizatiom degrees were more than 60%, the pressure of PV, SV, and SMV decreased significantly after embolization ( P <0 001). The decrease degree was (22 2±5 8)%, (28 5±1 7)%, and (19 5±8 1)%, respectively. The decreased degrees of pressure of both PV and SV after PSE were also positively related to the embolization degree ( r =0 645, P =0 032 for PV; r =0 687, P =0 020 for SV) Conclusion The embolization degree ranged from 60% to 80% may ameliorate peripheral blood WBC and PLT count, significantly decrease the blood flow and depress the pressure of portal vein, and relieve esophageal and gastric varices.