摘要
目的探讨脾切除加贲门周围血管离断术对肝脏血流动力学及肝脏功能的影响。方法选择32例行择期脾切除加贲门周围血管离断术的门静脉高压患者,观察术前及术后肝动脉血流量、门静脉血流量、门静脉内径、肝动脉内径、肝动脉流速峰值、肝动脉流速谷值、肝动脉阻力指数,采用终末期肝病模型(MELD)和吲哚青绿排泄试验(ICGR15)评价肝脏功能,术中测定自由门静脉压力。结果术后肝动脉血流量、门静脉血流量、门静脉内径、肝动脉内径、肝动脉流速峰值、肝动脉流速谷值、肝动脉阻力指数均呈逐渐变化的趋势,肝动脉血流量、肝动脉流速峰值、肝动脉流速谷值逐渐升高,门静脉血流量、门静脉内径、肝动脉内径、肝动脉阻力指数逐渐降低,术后8周内各指标变化的差异均有统计学意义(P<0.05)。开腹后、脾切除后、断流后自由门静脉压力差异有统计学意义(P<0.05),脾切除后、断流后均较开腹后降低(P<0.05),术后MELD和ICGR15均呈逐渐降低的趋势,差异有统计学意义(P<0.05),术后4周、8周均显著高于术前(P<0.05)。MELD与肝动脉血流量、肝动脉流速峰值呈负相关(P<0.05),ICGR15与肝动脉血流量、肝动脉流速峰值、肝动脉流速谷值呈负相关(P<0.05),MELD和ICGR15均与门静脉血流量、肝动脉阻力指数、自由门静脉压力变化值呈正相关(P<0.05)。结论脾切除加贲门周围血管离断术可有效改善门静脉高压血流动力学及肝脏功能。
Objective To investigate the impact of splenectomy plus pericardial devascularization on liver hemodynam- ics and function. Methods Chose 32 patients with portal hypertension amputation by treatment of splenectomy plus pericardial devascularization, observed liver blood flow, portal blood flow, portal vein, hepatic artery diameter, peak flow rate of hepatic artery, hepatic artery the flow rate of the valley, the hepatic artery resistance index in preoperative and postoperation, used MELD and ICGR15 evaluation of liver function, intraoperative measured free portal pressure . Results The postoperative hepatic arterial blood flow, portal blood flow, portal vein, hepatic artery diameter, peak flow rate of hepatic artery, hepatic artery flow velocity valley, hepatic artery resistance index showed a gradual change in trend, liver blood flow, hepatic artery flow velocity peaks, valleys hepatic artery flow velocity gradually increased portal blood flow, portal vein, hepatic artery diameter, hepatic artery resistance index decreased, after 8 weeks the difference of each index changes were statistically significant （P〈0.05）. The free portal pressure after laparotomy, after splenectomy, after cutoff were statistically significant （P〈0.05）, after splenectomy, after cutoff were lower than after laparotomy （P〈0.05）, and postoperative MELD, ICGR15 showed a decreased trend, the difference were statistically significant （P〈0.05）, after 4 weeks, 8 weeks were significantly higher than before surgery （P〈0.05）. MELD and liver blood flow, hepatic artery peak flow rate were negatively correlated （P〈0.05）, ICGR15 with hepatic blood flow, hepatic artery flow velocity peaks, valleys hepatic artery flow velocity were negatively correlated （P〈0.05）, MELD and ICGR15 respectively with portal blood flow, hepatic artery resistance index, free portal pressure change were positive correlation （P〈0.05）. Conclusion Splenectomy plus pericardial devascularization could effectively improve portal hypertension and liver function.
出处
《中国现代医生》
2014年第32期9-12,共4页
China Modern Doctor
基金
国家自然科学基金(81071587/H1511)
关键词
门静脉高压
脾切除术
断流术
血流动力学
肝脏功能
Portal hypertension
Splenectomy
Devascularization
Hemodynamics
Liver function
