门奇静脉断流加大网膜腹壁固定、腹壁曲张大网膜静脉-大隐静脉分流术的研究

Portal azygos disconnection combined with greater omentum fixed on the wall of abdomen and varicose epiploic vein-great saphenous vein shunt on portal hypertensive rats

目的 探讨门奇静脉断流加大网膜腹壁固定、曲张大网膜静脉 大隐静脉分流术的有效性及合理性。方法 Spraque Dawley(SD)大鼠 5 0只分为 3组 ,实验组 :Ⅰ期行贲门周围血管离断+门静脉主干缩窄 +大网膜腹壁固定术 ( 2 0只 ) ;Ⅱ期 (术后 2周 )加行腹壁皮下曲张的大网膜 大隐静脉分流术 ( 6只 ) ;对照组 :仅行贲门周围血管离断 +门静脉主干缩窄术 ( 2 0只 ) ;正常组 :即假手术组 ( 10只 )。各组术后观察 2周。结果 与对照组相比 ,实验组Ⅰ期术后几乎均能形成大网膜 腹壁静脉自然分流 ( 15只 /17只 ) ,使断流术后的门脉压力降低、食管下段静脉曲张及胃粘膜病变减轻 ;Ⅱ期再做腹壁曲张的大网膜 大隐静脉分流 ,可使分流量扩大、门静脉压力进一步下降。结论 本术式不但能达到断、分流联合术互相取长补短的效果 ,且还可能具有创伤小、简便易行等特点。因此 ,有必要进行进一步的研究以应用于临床。

Objective To observe the validity and rationality of the portal azygos disconnection combined with greater omentum fixed on the wall of abdomen and varicose epiploic vein-great saphenous vein shunt.Methods 50 Spraque-Dawley rats were divided into 3 groups randomly.The experimental group included 20 rats subject to portal azygos disconnection,narrowing the trunk of the portal vein and fixation of greater omentum on the wall of abdomen;6 rats whose subcutaneous varicose vein of abdominal wall was severe two weeks after the operation of the experimental group underwent subcutaneous varicos epiploic vein of abdominal wall-great saphenous vein shunt.The control group included 20 rats subject to portal azygos disconnection and narrowing the trunk of portal vein.Normal group included 10 rats receiving fake operation.Then a two-week observation was made.Results Compared with the control group,it was possible that the idiopathetic shunt formed after the portal azygos disconnection combined with the greater omentum fixed on the wall of abdomen in rats of the experimental group (15/17).The portal pressure was reduced after the portal azygos disconnection,and the varicosity and portal hypertensive gastropathy relieved.And varicose epiploic vein-great saphenous vein shunt could enlarge shunt volume,further reduce the portal pressure.Conclusion The operation not only obtains the superiority of the combination operation,but also features convenience and microtrauma.