门脉高压症时脐静脉或附脐静脉的血流动力学改变及临床意义

目的　探讨门静脉高压症 (PHT)时脐静脉或附脐静脉的血流动力学改变及临床意义 ,开创一种新的分流手术途径。方法　对 12例门静脉高压症脐静脉或附脐静脉开放扩张的病人 ,测量其自由门脉压 (FPP)、脏侧门脉阻断压 (SOPP)、肝侧门脉阻断压 (HOPP)、脐静脉或附脐静脉压 (PU VP)、脐周皮下曲张静脉压 (PU SVP)及脐静脉或附脐静脉肝门阻断压(PUVOPP) ,并进行对比分析。结果　 PU VP与 FPP的结果无显著性差异 (P>0 .0 5 ) ;PU VP明显于 PUSVP,存在显著性差异 (P<0 .0 1) ;HOPP与 PU VOPP的差异无显著性 (P>0 .0 5 ) ;MPP(SOPP- HOPP)与 (SOPP- PU VOPP)的差异无显著性 (P>0 .0 5 )。结论　 (1) PHT时 ,PU VP与 FPP结果基本一致 ;(2 )门脉最大灌注压 (MPP)可大约用 SOPP与 PU VPP的差表示 ;(3) PHT时 ,PU VP明显高于 PUSVP,说明脐静脉或附脐静脉开放后自我分流的有效性不大 ;(4 )脐静脉或附脐静脉下腔静脉分流术开辟一种全新的有效的分流手术途径

THE CLINICAL SIGNIFICANCE AND HEMODYNAMIC CHANGES OF UMBILICAL OR PARAUMBILICAL VEIN IN PORTAL HYPERTENSION

Objective To investigate the clinical significance and hemodynamic changes of umbilical or paraumbilical vein in portal hypertension(PHT),and found a new method of shunt operation.Methods 12 cases with PHT who underwent umbilical or paraumbilical vein opened or dilated were involved to measure their FPP,SOPP,HOPP,paraumbilical vein pressure(PUVP),periumbilical subcutaneous verical pressure(PUSVP) and paraumbolical vein occluded portal pressure(PUVOPP).Result There was no difference between PUVP and FPP(P>0.05).PUVP was much higher than PUSVP(P<0.01).There was no difference between HOPP and PUVOPP(P>05),so did MPP and SOPP-PUVOPP(P>0.05).Conclusion (1)PUVP is approximately equal to FPP in PHT.(2)MPP should be able to representated by the dispersion of SOPP and PUVOPP.(3) PUVP is much higher than PUSVP,which indicates that the flux of umbilical or paraumbilical vein is ineffective.(4) Umbilical or paraumbilical-caval shunt is a new and effective operation to treat PHT.