腹腔镜下贲门周围血管离断术对门静脉系统和肝动脉血流动力学的影响

目的探讨腹腔镜下贲门周围血管离断术(laparoscopic splenectomy plus pericardial devascularization,LSD)对门静脉系统和肝动脉血流动力学的影响。方法 2011年1月至2017年12月空军军医大学第二附属医院普通外科收治门静脉高压症病人270例,所有病人均接受了LSD治疗,观察和比较手术前后门静脉、肠系膜上静脉和肝动脉在直径、血流速度、血流量等方面的差异。结果①LSD手术后门静脉直径、门静脉血流速度、门静脉血流量均明显小于术前(P<0.001);②肠系膜上静脉直径明显小于术前(P<0.001),肠系膜上静脉血流速度与术前比较差异无统计学意义(P=0.915),肠系膜上静脉血流量小于术前,但差异无统计学意义(P=0.065);③术后肝动脉直径明显大于术前(P=0.001),最大血流速度、最小血流速度和平均血流速度均明显大于术前(均P<0.01),肝动脉血流量也明显大于术前(P=0.02)。结论从血流动力学变化来看,LSD能明显改善门静脉系统的高动力循环状态,而不会影响消化道的静脉回流,同时能够明显改善肝脏动脉灌注,对于门静脉高压症预后有着积极的临床意义。

Effects of laparoscopic pericardial devascularization on hemodynamics of the portal venous system and hepatic artery

Objective To investigate the effects of laparoscopic splenectomy plus pericardial devascularization on hemodynamics of the portal venous system and hepatic artery. Methods A total of 270 patients with portal hypertension admitted to the Department of General Surgery of the Second Affiliated Hospital of Air Force Military Medical University from January 2011 to December 2017 were retrospectively analyzed. All patients underwent laparoscopic splenectomy plus pericardial devascularizationn. The differences in diameter, blood flow velocity, and blood flow between the portal vein, superior mesenteric vein, and hepatic artery before and after surgery were observed and compared. Results ①Hemodynamic changes of portal vein system: Our data exhibited that the diameter, the blood flow velocity and the blood flow of portal vein were significantly reduced after surgery (P<0.001 ). The diameter of superior mesenteric vein decreased significantly (P<0.001). There was no difference observed in the velocity of superior mesenteric vein (P=0.915). The mean blood flow volume of superior mesenteric vein was reduced after surgery, but no significant difference was identified (P= 0.065 ).②A marked increase in hepatic artery diameter was observed(P=0.001). The maximum blood flow velocity, minimum blood flow velocity and mean blood flow velocity of the hepatic artery all significantly increased after the operation (P<0.01). The Hepatic artery blood flow were also increased significantly (P=0.02). Conclusion With regard to the hemodynamic changes, laparoscopic splenectomy plus pericardial devascularization can significantly improve the hyperdynamic circulatory state of the portal venous system without affecting the venous reflux of the digestive tract while can significantly improve the hepatic arterial perfusion, which has positive clinical implication for the prognosis of portal hypertension.