摘要
目的探讨肝硬化门静脉高压患者行选择性脾胃区减断分流术(SDDS—GSR)后肝脾血流动力学的改变及临床意义。方法前瞻性收集41例行SDDS—GSR术治疗患者的超声检查资料,按术前、术后2周及术后1年分为3期,并以21例正常体检患者为对照进行研究。结果(1)脾脏厚度在术后2周(47±8)mm及术后1年(46±8)mm较术前(60±9)mm显著减小(P〈0.01)。(2)术后2周门静脉直径(1.13±0.19)cm较术前显著变窄(P〈0.01),脾动脉直径(0.49±0.08)cm较术前显著变窄(P〈0.05),肝动脉直径(0.40±0.07)am较术前显著增宽(P〈0.05)。术后1年门静脉直径(0.89±0.17)cm均较术前显著变窄(P〈0.01)。(3)术后2周门静脉血流量(649±294)ml/min和脾动脉血流量(446±254)ml/min较术前显著减小(P〈0.01),肝动脉缸流量(612±295)ml/min较术前湿著增加(P〈0.01)。术后1年肝动脉血流量(401±152)ml/min与术前和正常组比较差异均无统计学意义(P〉0.05)。结论肝硬化门静脉高压症患者肝脾血流动力学参数发牛异常变化;SDDS—GSR有助于纠正肝硬化门静脉高压症患者肝脾血流动力学的紊乱状态。
Objective To evaluate the changes of splanehnie hemodynamics after selective deeongestive devascularization shunt of gastrosplenic region (SDDS-GSR) in the treatment of patients with portal hypertension. Methods All these 41 portal hypertensive patients underwent a combination surgery including partially occlusion of the splenic artery', Warren distal splenorenal shunt and devascularization. Postoperative patients were followed-up by uhrasonography for changes of splanchnic hemodynamies. Results were compared with that of 21 healthy volunteers. Results The thickness of spleen 2 weeks and 1 year after surgery (47±28) mm, (46±28) mm decreased from preoperative (60±29) mm (P 〈0.01 ). The diameter of portal vein ( 1.13± 0. 19 ) em and splenic artery ( 0.49± 0. 08 )cm 2 weeks after surgery deereased (P 〈 0.05 ) and that of hepatic artery (0. 40± 0. 07 )em increased ( P 〈 0. 05 ). Patients' preoperative portal vein blood flow volume (1716 ± 1262) ml/min and splenic artery (1269± 570) ml/min were larger than that of normal group (P 〈 0. 05 ), while that of hepatic artery (321 ± 126) ml/min was significantly less than that of normal group ( P 〈 0. 05 ). The portal blood flow ( 649 ± 294 ) ml/min and that of splenie artery, (446 ±254) ml/min 2 weeks after surgery deereased significantly (P 〈0. 01 ). The hepatic artery blood flow (612 ± 295) ml/min increased signifieantly (P 〈 0.01 ). When reevaluated at 1 year the hepatic artery blood flow (401± 152) ml/min was not significantly different compared with that before surgery and that in normal group ( P 〉 0. 05 ). Conclusions There are significant alterations in hepatic and splenic hemodynamics in patients with portal hypertension, and that SDDS-GSR can partially reverse the chaos of the hepatic and splenic hemodynamics in cirrhotic portal hypertensive patients.
出处
《中华普通外科杂志》
CSCD
北大核心
2009年第9期711-714,共4页
Chinese Journal of General Surgery