生长抑素对门脉高压病人脾切除手术前后门脉压力的影响

The effects of somatostatin on portal venous pressure in patients with portal hypertension before and after splenectomy

目的 :探讨思他宁对肝硬化门脉高压病人行脾切除手术前后门脉压力的影响。方法 :肝硬化门脉高压脾肿大、脾功能亢进病人 2 5例 ,随机分治疗组 (思他宁组 ) 15例 ,对照组 10例 ,术前 1d及术后第 2天用彩色多普勒测定门脉主干内径、血流速度及血流量。手术中开腹后和术毕关腹前分别经胃网膜右静脉分支测得门静脉压力。治疗组在使用思他宁 5min后测门脉压力一次 (思他宁静脉维持 4 8h) ,记录术中出血量、术后第 1天脾窝引流管引出量。结果 :治疗组 :①使用思他宁前后门脉压力差异有极显著性 (P <0 .0 1)。在思他宁维持过程中 ,行脾切除前后门脉压力差异有显著性 (P <0 .0 5 )。②使用思他宁前后和脾切除术前后门脉内径差异无显著性 ,最大流速及血流量差异有极显著性 (P <0 .0 1)。对照组 :①脾切除前后门脉压力、最大血流量及血液流速差异有显著性 (P <0 .0 5 )。②门脉内径差异无显著性。两组术中出血量 ,术后第 1天腹腔引流管引出量差异有极显著性 (P <0 .0 1)。结论 :周围静脉持续生长抑素维持能降低门脉高压病人脾切除术后的门脉压力 ,降低门脉压力的机制可能是通过降低门脉血流速率从而降低门静脉血流量。

Objective:To investigate the effects of somatostatin on portal venous pressure in patients with portal hypertension.Methods:25 hepatic cirrhosis patients with portal hypertension and hypersplenism were devided into study group and control group,study group was made up of 15 cases and control group was comprised of 10 cases. Internal diameters of portal vein,the blood flow and blood flow velocity in the portal vein were measured with color doppler in 25 patients before and after splenectomy. The portal pressure was also measured by color doppler before and after operation. In addition,the portal pressure in the study group was measured after injecting somatostatin in five minutes,the amount of bleeding during the operation and the amount of drainning from the abdomen drain in the first day were recorded.Results:Study group:①The portal vein pressure was reduced significantly by using somatostatin(P<0.01),and the portal vein pressure could also be reduced by splenectomy during using somatostain(P<0.05).②The reduction of the maximal amount of blood flow and blood flow velocity of portal showed significant difference between before and after using somatostatin or splenectomy(P<0.01),but the internal diameters showed no difference. Control group:①There were differences in the pressure,maximal amount of blood flow and blood flow veloctiy of the portal before and after splenectomy(P<0.05).②The internal diameters showed no difference before and after splenectomy. However,there were significant differences in the amount of bleeding during operation and the amount of drain from abdomen drainage tube in the first day between the two groups(P<0.01)。Conclusion:Continuous instillation of somatostatin via peripheral vein can decrease the portal venous pressure in cirrhotic patients with portal hypertension. The mechanism may be the decrease of hemokinetic volume caused by the decrease of hemokinetic velocity of the portal vein. After administration of somatostatin,the amount of bleeding was significantly decreased during and after operation.