间接门静脉造影判断肝血管瘤血供来源

探讨间接门静脉造影对判断肝血管瘤血供来源的临床价值。方法78例经临床和影像学资料证实的肝血管瘤患者,其中56例经肠系膜上动脉行间接门静脉造影,观察造影表现及对肿瘤供血情况,所有患者经动脉途径进行栓塞治疗,术后2～3个月CT、B超随访观察疗效。结果间接门静脉造影示门静脉显影清晰,未见异常扩张、畸形,且均未见向肿瘤供血;部分患者门静脉造影实质期瘤体呈低密度充盈缺损区,瘤体大者门静脉分支被推移。所有肝血管瘤都由肝动脉供血,栓塞术后随访有效率达84.6%。结论间接门静脉造影能在生理状态下对肝血管瘤患者门静脉进行观察,可为判断肝血管瘤血供来源及决定栓塞治疗方案提供帮助。     

肝癌血供研究进展

对于不能手术切除的肝脏恶性肿瘤,经血管途径行介入治疗可获得可靠疗效。所以准确的描述肿瘤血供对肝癌的介入治疗就显得尤为重要。近年来研究表明,肝癌血供较为复杂,存在肝动脉、肝外侧支、门静脉供血及肝动脉门静脉双重供血等情况。随着介入治疗次数的增加,肝癌血供亦发生变化。肝癌血供研究直接影响对其介入治疗方式的选择和疗效。     

探讨肝癌肝外供血的形成规律及介入治疗

目的探讨肝癌的肝外动脉供血规律,插管技术,旨在指导介入治疗。方法分析46例肝癌患者54条肝外动脉供血的特征,对肝外动脉供血支超选插管,并行动脉化疗栓塞术。结果肝外动脉供血与肿瘤部位、大小密切相关;RH、Cobra导管配合SP导管使用,肝外动脉供血支插管成功率为81%。4~6周复查,CT显示肿瘤缩小,碘油沉积致密完全。结论肝癌可有丰富的肝外动脉供血,明确肝癌肝外动脉供血的形成机制对临床准确和彻底阻断肝癌的动脉供血,提高肝癌介入治疗的效果具有重要的意义。     

肝外供血动脉栓塞在巨块型肝癌治疗中的价值

目的探讨经导管肝外供血动脉栓塞在治疗巨块型肝癌中的价值。方法对35例巨块型肝癌,首次行经导管肝动脉化疗栓塞术（TACE）,第2次及其后在肝动脉TACE基础上加行经右侧胸廓内动脉、右侧肋间动脉侧支供血动脉栓塞术。结果本组35例巨块型肝癌患者,发现肝外侧支49支,对46支使用微导管进行栓塞治疗,3支行超选择灌注化疗。初次TACE治疗时肝外血供多有膈下动脉参与,治疗过程中,随着肿瘤的增大或肝动脉的闭塞,胸廓内动脉、肋间动脉、胰十二支肠动脉弓等血管有可能参与。结论对肝外侧支血管应用微导管超选择栓塞或灌注化疗均能加强TACE在巨块型肝癌治疗中的作用,提高患者带瘤生存期。     

原发性肝癌经动脉化疗栓塞供血改变

目的研究经动脉化疗栓塞(TACE)治疗原发性肝癌的供血变化,用以改进和完善原发性肝癌的介入治疗。方法回顾126例进行过TACE的原发性肝癌患者,观察分析其血管变化情况。结果原发性肝癌患者血供随着介入治疗次数的增加而更加复杂,肝动脉狭窄闭塞率分别为0.8%(第1次)、11.9%(第2次)、18.4%(第3次)、35.3%(第4次)、60.0%(>4次);肝外侧支循环发生率分别为9.4%(第1次)、14.9%(第2次)、21.1%(第3次)4、1.2%(第4次)8、0.0%(>4次);肝外侧支循环形成与肿瘤的发生部位有着一定的联系,发生率高的是肝脏的7、8段,再者分别为5、6段和肝左叶。结论原发性肝癌患者血供随着介入治疗次数的增加而更加复杂,应积极对肿瘤供血动脉充分找寻和完全栓塞,以求最大疗效和减少并发症等。     

中晚期肝癌肝外供血分析及临床介入治疗

目的探讨肝癌的肝外动脉供血规律及介入治疗。方法92例肝癌患者发现肝外供血动脉105条，分别超选择插管行化疗栓塞。结果中晚期肝癌肝外动脉来源类型分别源于肠系膜上动脉（33．33％）、右膈下动脉（17．14％）、胃十二指肠动脉（14．29％）、左膈下动脉（7．62％）、胃左动脉（6．67％）、右肋间动脉（6．67％）、右肾上腺动脉（4．76％）、脾动脉（4．76％）、右腰动脉（2．86％）和右胸廓内动脉（1．90％）。形成肝外动脉的影响因素较多，包括化疗栓塞的次数、肿瘤在肝内的部位、肿瘤的直径和操作方法。结论肝癌有丰富的肝外动脉供血，对肝外动脉供血支超选择性栓塞治疗，对提高中晚期肝癌患者介入治疗疗效具有重要的临床意义。     

胃癌血供与供血动脉插管化疗的临床观察

胃癌血供与供血动脉插管化疗的临床观察浙江省人民医院（３１００１４）普外科邹寿椿，裘华森放射科陈方宏，袁建华胃癌术前进行选择性动脉插管化疗对癌灶的局限和缩小，提高切除率和根治程度的作用，已得到多数学者的肯定。但文献报道仅局限于临床和病理学上的观察［１，...     

肝泡状棘球蚴病门脉血供的实验研究

目的观察活体碘油门静脉灌注在大鼠肝泡状棘球蚴病模型中的分布,初步探讨肝泡状棘球蚴病的门脉血供。方法30只健康Wistar大鼠随机分为健康对照组(10只)和实验组(20只)。两组又各分为3个亚组,正常组每个亚组分别为4只、3只和3只大鼠。实验组20只感染肝泡球蚴病的大鼠每个亚组分别为8只、6只和6只大鼠。所有动物均开腹直视下穿刺门静脉,于透视下缓慢注射碘化油0.2 ml,分别在15 min、4 d和7 d后处死动物,取新鲜肝脏行钼靶摄影后进行HE染色及苏丹Ⅳ染色,观察碘油分布。结果活体条件下对感染肝泡球蚴病的大鼠经门静脉灌注碘油后,通过低电压X线摄影共9只实验动物肝脏中可见碘化油选择性地进入病灶,而苏丹Ⅳ染色有8只于病灶周围的炎症反应带中可见碘油沉积,两者的差异无统计学意义(P>0.05)。结论①活体碘油门静脉灌注方法简单易行,结果真实可靠;②门静脉参与了部分晚期肝泡状棘球蚴病灶的供血;③本实验为肝泡球蚴病双重途径介入治疗的实验研究提供了可靠的理论依据。     

Effect of endotoxemia on hepatic portal and sinusoidal blood flow in rats

A decrease in liver blood flow leads to dysfunction of hepatocytes and Kupffer cells, with subsequent local and systemic liberation of proinflammatory mediators that may maintain systemic inflammatory response syndrome (SIRS) and may lead to multiple organ dysfunction syndrome (MODS). There is only limited knowledge on the hepatic micro- and macrocirculation during sepsis or endotoxemia. Therefore, the aim of our study was to investigate alterations in hepatic portal blood flow (PBF) and sinusoidal blood flow (SBF) during endotoxemia. In male Wistar rats endotoxemia was induced by continuous infusion of 2 mg/kg/h lipopolysaccharides from Escherichia coli 026:B6 immediately after baseline measurements (n = 8). The control group (n = 8) received an equivalent volume of Ringer's solution. Mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), PBF, and SBF were measured at baseline and 60 and 120 min after induction of endotoxemia. PBF was measured using an ultrasonic flow probe that was positioned around the portal vein. SBF was detected by in vivo videomicroscopy of the left liver lobe. In the LPS group MAP decreased, but CO remained at baseline values. During endotoxemia PBF decreased significantly from 23 +/- 3 to 15 +/- 4 mL/min (60 min) and 16 +/- 3 mL/min (120 min). SBF also significantly decreased to 68.5% (60 min) and 57.1% (120 min) of baseline value. Our results demonstrate that during early endotoxemia hepatic macro- and microcirculatory perfusion is significantly decreased despite unchanged CO. This early reduction of hepatic perfusion might be caused by an increased hepatic vessel resistance as a consequence of liberation of vasoconstrictive mediators or/and by a decrease in intestinal perfusion.     

肝癌供血动脉变异1例

Hepatic arteries;Variation;Hepatic neoplasms     

Hepatofugal portal blood flow in hepatic cirrhosis.

A variety of indirect techniques has been claimed to provide evidence of spontaneous reversal of portal blood flow in hepatic cirrhosis but the existence of the phenomenon has been doubted by some who do not accept the validity of the indirect evidence. There are few reports of the demonstration of hepatofugal portal flow by selective hepatic arteriography, which is the only acceptable technique. We report three patients with histologically confirmed cirrhosis in whom hepatofugal portal blood flow was unequivocally demonstrated by arteriography, in whom no surgical portosystemic shunt had been performed and in whom there was no evidence of the Budd-Chiari Syndrome or hepatoma, situations accepted as associated with reversed portal blood flow. Theoretical considerations suggest that shunt surgery for bleeding esophageal varices should not be ruled out on the grounds of hepatofugal portal flow. However, end-to-side portacaval anastomosis and distal splenorenal shunt might predispose to the early redevelopment of esophageal varices when reversed portal flow is present. Side-to-side portacaval and conventional splenorenal shunts might be preferable in having less effect on hepatic parenchyma perfusion than when orthograde portal flow in the case.     

大鼠门静脉接受不同血供对肝脏缺血再灌注损伤的影响

目的 观察大鼠门静脉接受不同血供对肝脏缺血再灌注损伤的影响.方法 雄性SD大鼠120只,随机分为门静脉动脉化组(A组)、门腔转位组(B组)和对照组(C组).观察各组大鼠的生存情况,分别在术后6h、12 h、1d、3d及7d检测血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、一氧化氮(N0)、血浆内皮素-1(ET-1)以及肝脏病理.结果 B组生存时间明显低于A、C两组.术后6h、12h、1d及3d,A组大鼠ALT及AST均显著低于B组和C组;而在术后1d和术后3d时,B组ALT及AST均高于C组;术后6h、12h及1d,A组大鼠血清NO与血浆ET-1均显著低于B组和C组;在术后6h和术后12h时,B组血清NO与血浆ET-1均高于C组,差异有统计学意义.结论 大鼠门静脉接受动脉化较门腔转位术更有利于促进近期肝脏缺血再灌注损伤的恢复.     

大鼠门静脉转流下耐受入肝血流阻断的安全时限

目的 评估在排除门静脉淤血条件下动物耐受入肝血硫阻断的安全时限。方法 利用大鼠肝脏及肝蒂分支分叶的解剖特点,阻断肝左、中和右叶肝蒂,以尾叶静脉系统作为阻断入肝血流期间门静脉血液的流出道,肝脏复流后切除尾叶。在这一模型上,以阻断入肝血流不同时程后动物7d存活率、肝脏病理组织学改变及肝脏能量代谢功能损害的严重度及可逆性来推断动物耐受常温下入肝血流阻断的安全时限。结果 门静脉转流下阻断入肝血流90min以内,术后7d动物全部存活,其肝脏缺血-再灌流损害以肝窦淤血和肝细胞变性等可逆性病变为主,而肝脏能量代谢功能损害可得以代偿和恢复。阻断入肝血流100、110、120min后动物7d存活率分别为50％、30％和20％,肝脏缺血120min后肝脏缺血-再灌流损害则以大量肝组织坏死为显著特性,其肝脏能量代谢功能严重受损而陷入失代偿状态。结论 大鼠在门静脉轻流时对常温下持续入肝血流阻断的耐受性显著增强,其安全时限是90min。     

Auxiliary canine hepatic transplantation without portal blood flow

Auxiliary liver transplantation for acute reversible hepatic failure has been suggested as a way to provide temporary hepatic support. The major technical difficulty in such an operation is providing portal blood flow, although it is unclear if this is necessary for short-term function of such a graft. Three groups of five dogs each underwent common duct ligation and cholecystectomy. One week later all animals underwent an end-to-side portocaval shunt. In Group I dogs only a "sham" transplant was done while those in Group II also received an auxiliary hepatic graft without portal blood flow which had been perfused with iced Collins solution and immediately grafted. Group III received similar auxiliary hepatic grafts with 22 hours of cold ischemia time. Reductions in mean total serum bilirubin values to near normal, usually lasting for one week (Group I, 12.02 mg% +/- 1.23 SEM vs. Group II, 3.58 mg% +/- 0.52 SEM, p = 0.01) were observed. Although several livers stored for 22 hours demonstrated function, there was considerable evidence of ischemic injury.