肝硬化门静脉高压症患者Hassab术后门静脉血流动力学变化及意义

用彩色多普勒检测肝硬化门静脉（PV）高压症患者Hassab术后不同时期PV主干和门静脉左支（LPV）、右支（RPV）内径及最大血流速度、平均血流速度,评价术后不同时期Child-Pugh肝功能分级。结果与术前比较,Hassab术后12个月时PV主干内径、RPV内径较术前14 d时缩小（P〈0.05）,LPV变化不明显（P〉0.05）,PV主干和LPV最大血流速度、LPV平均血流速度减慢,血流量减少（P〈0.05）。RPV平均血流速度在术后6个月时较术前减慢（P〈0.05）。术后3~24个月Child-Pugh A级患者比例升高,与术前比较,P〈0.05。认为Hassab术后12个月,PV主干及RPV内径不同程度缩小,其血流速度、血流量均不同程度减慢、减少。术后24个月内肝功能改善明显。     

门静脉血流速度变化与食管胃底静脉曲张的相关性研究

目的分析门静脉血流速度变化与食管胃底静脉曲张的相关性。方法在院内收治的慢性肝病门静脉高压患者60例作为观察对象,应用胃镜与超声观察食管胃底静脉曲张与门静脉血流动力学改变情况,经由一系列调查结果分析门静脉血流速度变化与食管胃底静脉曲张关联。结果术前重度食管静脉曲张率63. 33%,术后6个月重度食管静脉曲张率23. 73%,术后12个月重度食管静脉曲张率32. 76%,术后18个月重度食管静脉曲张率37. 50%,术后24个月重度食管静脉曲张率45. 28%。随着时间的延长,轻度食管静脉曲张患者胃底静脉曲张发生率较低,中度食管静脉曲张患者胃底静脉曲张发生率较高,重度食管静脉曲张患者胃底静脉曲张发生率最高,三组之间对比差异显著。轻度患者血流速度与ALB明显大于其他两组,重度食管静脉曲张患者的血流速度与ALB最慢,明显小于其他两组,组间对比差异显著;重度食管静脉曲张患者的INR为1. 45±0. 05,明显大于其他两组,组间对比差异显著。结论食管胃底静脉曲张属于慢性肝病的主要并发症,可用手术方案加以治疗,而本次研究进一步证实,门静脉血流速度变化与食管胃底静脉曲张之间存在着负相关关系,静脉曲张越严重则门脉血流速度越慢。为此,在临床诊治中,可经由门静脉血流速度的观察,判断食管胃底静脉曲张程度。     

部分脾动脉栓塞术对肝硬化门静脉高压症血流动力学的影响

目的探讨部分脾动脉栓塞术（PSE）治疗肝硬化门静脉高压症的临床疗效及应用价值。方法 23例不同原因肝硬化门静脉高压患者行PSE治疗,PSE术前及术后1周、1、3、6个月彩色多普勒分别检测患者门静脉和脾静脉的内径、血流速度,计算血流量,并与PSE术前配对分析。结果术后各期患者脾静脉、门静脉血流速度及血流量较术前降低（P〈0.05）;脾静脉内径术后各期与术前相比明显缩小（P〈0.05）;而门静脉主干内径术后6个月内缩小不明显（P〉0.05）。结论 PSE能有效的降低门静脉压力。     

药物联合内镜治疗预防肝硬化门静脉高压食管胃静脉曲张再出血的疗效观察

目的观察药物（普奈洛尔）联合内镜（套扎或/和组织胶）治疗预防肝硬化门静脉高压食管胃静脉曲张再出血的疗效。方法将65例肝硬化门静脉高压食管胃静脉曲张出血经内科药物治疗出血停止的患者随机分为2组：治疗组34例,采用普奈洛尔联合内镜治疗（对单纯食管静脉曲张行套扎治疗,对食管胃静脉曲张行套扎治疗＋组织胶治疗）;对照组31例,单用普奈洛尔治疗。随访12个月,观察治疗后患者再出血率、死亡率等。结果随访12个月期间再出血率治疗组20.6%（7/34）,对照组32.3%（10/31）,差异有统计学意义（P〈0.05）;死亡率治疗组8.8%（3/34）,对照组9.7%（3/31）,差异无统计学意义（P〉0.05）。结论药物联合内镜治疗可以有效预防肝硬化门静脉高压食管胃静脉曲张再出血,提高患者生活质量,值得临床推广。     

经皮经肝食管胃底静脉栓塞断流术对肝功能的影响

目的探讨食管胃底静脉栓塞术（percutaneous transsplenic variceal embolization PTVE）治疗肝硬化门静脉高压性上消化道出血,对患者肝功能的影响。方法通过经肝经门静脉食管胃底静脉栓塞断流术治疗有食管胃底静脉曲张出血的肝硬化患者36例,对照组30例采用内科保守治疗,随访6个月的肝功能指标、Child-Pugh分级变化和出血复发率,进行对比。结果观察组的肝功能指标：ALB、TBil、PTA和NH3,与对照组对比P值分别为〈0.05、〈0.01、〈0.01和〈0.001;Chind-Pugh分级与对照组对比,P〈0.01,有显著性差异;观察组出血再发率也明显低于对照组,8.33%对26.7%,P〈0.05,两组对比显著性差异。结论食管胃底静脉栓塞断流术不仅能减少门静脉高压性上消化道出血复发率降低,同时能改善肝硬化患者的肝功能状况。     

TH胶栓塞联合门体静脉小分流治疗肝硬化门脉高压食管胃底静脉曲张出血

目的探讨应用TH胶栓塞联合门体静脉小分流治疗门脉高压食管胃底曲张静脉曲张破裂出血中的应用价值。方法入选41例门静脉高压症并食管胃底静脉曲张的患者,其中21例行TH胶栓塞联合门体静脉小分流术（A组）,另外20例患者行经皮经肝食管胃底曲张静脉栓塞术（PTVE）联合部分性脾栓塞（PSE）（B组）,对比两组患者肝功能、白细胞、血小板改变、食管胃底曲张静脉消失率、再出血率、肝性脑病发生率及门静脉自由压（free portal pressure,FPP）变化。结果 A组曲张静脉消失率、总有效率均高于B组（P〈0.05）,再出血率、肝性脑病发生率均低于B组（P〈0.05）,术后门静脉压力亦明显低于B组（P〈0.01）。两组术后白细胞及血小板、白蛋白较术前明显升高,差异有统计学意义（P〈0.01）,两组之间也存在显著统计学差异（P〈0.01）。结论以TH胶栓塞联合门体静脉小分流治疗门静脉高压症食管胃底静脉曲张安全、有效、并发症少,值得临床应用与推广。     

部分脾栓塞联合心得安预防食管胃底静脉曲张再出血的研究

[目的]评价部分脾动脉栓塞术（PSE）联合心得安预防食管胃底静脉曲张再出血的临床疗效.[方法]55例食管胃底静脉曲张破裂出血患者,随机分为两组,其中心得安组28例,PSE联合心得安组27例,比较两组患者外周血象变化,门静脉、脾静脉管径变化,以及3个月、6个月、1年、2年不同时间段的再出血率、病死率和并发症情况.[结果]术后1个月PSE联合心得安组较心得安组外周血白细胞及血小板显著升高,门静脉及脾静脉管径明显缩小,再出血率降低,差异有统计学意义（P＜0.05）.[结论] PSE联合心得安预防食管胃底静脉曲张再出血较单独使用心得安有更好的疗效.     

原发性胆汁性肝硬化患者食管静脉曲张程度与肝功能评价的相关性研究

目的 探讨原发性胆汁性肝硬化食管静脉曲张程度与门脾静脉内径、肝功能Child-Pugh分级,Meld评分间的关系.方法 对2008年9月至2011年5月间选择92例原发性胆汁性肝硬化患者行增强CT,测量门静脉主干及脾门部脾静脉直径,行胃镜了解食管静脉曲张的程度,并对其中44例出现过静脉曲张破裂出血患者采用Child-Pugh分级,Meld评分标准进行肝功能分级.结果 食管静脉曲张程度与门静脉内径（P =0.018）、脾静脉内径（P=O.O02）呈正相关,而Child-Pugh分级（P＞0.05）,Meld评分（P＞0.05）则与食管静脉曲张程度无相关性.结论 根据门、脾静脉内径可预测原发性胆汁性肝硬化的食管静脉曲张程度;而Child-Pugh分级,Meld评分对患者的食管静脉曲张程度及出血风险不能进行有效评估.     

经皮经肝食管胃底曲张静脉栓塞术联合部分脾栓塞术治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

背景:食管胃底静脉曲张破裂出血是肝硬化门静脉高压常见且严重的并发症,再出血的预防是该病的治疗重点。目的:评价经皮经肝食管胃底曲张静脉栓塞术(PTVE)联合部分脾栓塞术(PSE)治疗肝硬化食管胃底静脉曲张破裂出血的疗效和安全性。方法:前瞻性选择10例肝硬化食管胃底静脉曲张破裂出血患者行PTVE联合PSE术,术前、术后行门静脉系统多普勒超声和血常规检查,记录超声血流变化和外周血细胞变化情况。术后随访1~2年,观察再出血和并发症发生情况。结果:PTVE联合PSE术后,患者门静脉主干较术前明显变细,门静脉主干和脾静脉血流速度减慢,术后3个月外周血白细胞和血小板计数仍高于术前,差异均有统计学意义(P0.05)。术后1年内2例患者发生再出血,再出血率为20.0%,其中1例复查见门静脉主干血栓形成,发生率为10.0%。该例患者术后胃底静脉曲张基本消失,予内镜下食管曲张静脉套扎治疗后未再复发。结论:PTVE联合PSE术能有效降低门静脉系统压力,是治疗肝硬化食管胃底静脉曲张破裂出血安全、有效的介入治疗方法。     

经皮胃冠状静脉栓塞术联合脾动脉主干截流术治疗肝硬化盗血综合征临床研究*

目的观察经皮胃冠状静脉栓塞术联合脾动脉主干截流术治疗肝硬化盗血综合征患者的疗效。方法在89例肝硬化并发脾功能亢进症伴食管胃底静脉曲张破裂出血患者中,53例接受经皮胃冠状静脉栓塞术联合脾动脉主干截流术治疗,36例行脾动脉主干截流术治疗。在术后1个月、6个月、12个月观察肝功能、血常规等指标变化及再出血和生存情况。结果术后1个月、6个月、12个月联合组再出血率分别为0.0%、5.7%和15.1%,而脾动脉主干截流术治疗患者分别为0.0%、16.7%（P<0.05）和44.4%（P<0.05）;术后两组白细胞和血小板计数均升高,但在6个月后又有所下降,两组生存患者 Child-Pugh评分无显著相差（P>0.05）。结论采用经皮胃冠状静脉栓塞术联合脾动脉主干截流术治疗肝硬化并发食管胃底静脉曲张破裂出血患者损伤小、安全性好,控制再出血作用肯定。     

经皮经肝曲张静脉栓塞治疗断流术后食管胃底静脉破裂出血的疗效

目的 研究以组织胶为主要栓塞材料,采用经皮经肝曲张静脉栓塞术(PTVE)治疗和预防门奇静脉断流术后食管胃底静脉曲张破裂出血的临床疗效.方法 2006年11月至2008年9月,对22例曾行断流术再发食管胃底静脉曲张破裂出血的患者行PTVE组织胶栓塞(n=10)或内镜下硬化剂(EIS,n=12)治疗,随访两组患者治疗后再出血率、死亡率、治疗前后静脉曲张和肝功能以及PTVE治疗组患者在曲张侧支静脉栓塞前后门静脉压力的变化.结果 ①在平均12.5个月的随访期内,PTVE治疗组患者再出血率和死亡率分别为1/10和0;EIS治疗组随访13.4个月,患者再出血率和死亡率分别为7/12和3/12,两组问差异有统计学意义(P<0.05).②PTVE和EIS治疗均可显著减轻食管和胃底静脉曲张程度.③对有门静脉血栓患者,PTVE联合门静脉球囊成形术,可以改善肝脏门静脉血供.④PTVE和EIS治疗均未加重肝功能损伤.结论 对门奇静脉断流术后食管胃底静脉破裂出血的患者,采用以组织胶为主要栓塞材料的PTVE治疗的疗效优于EIS治疗.     

肝硬化食管静脉曲张出血内镜治疗后早期再出血的危险因素分析

目的探讨内镜治疗肝硬化食管静脉曲张破裂出血(EVB)后早期再出血的危险因素。 方法回顾分析2016年8月至2018年8月因肝硬化食管静脉曲张(EV)首次出血就诊于包头医学院二附院并采用内镜下治疗的患者资料,依据术后6周内是否再出血分再出血组和未出血组,对两组患者的一般资料、肝功能、血常规、凝血、门静脉血栓、门静脉异常分流等情况进行单因素分析,探讨内镜治疗EV术后早期再出血的危险因素。 结果(1)入组患者共450例,治疗后6周内出血27例,止血成功率94%;(2)单因素分析AST、GGT、TBIL、ALB、PTA、TG、肝功能、Child-Pugh分级、EV程度、门静脉血栓、门静脉异常分流在出血和未出血组之间的差异具有统计学意义;(3)多因素Logistic回归分析结果显示AST等是影响EV术后再出血的危险因素;ALB、门静脉异常分流是影响EV术后再出血的保护因素(P<0.05)。 结论AST、GGT、PTA、TG、肝功能Child-Pugh分级、EV程度、门静脉血栓是影响EV术再出血的危险因素;ALB、门静脉异常分流是影响EV术后早期再出血的保护因素。     

Intra-operative evaluation of portal pressure and immediate results of surgical treatment of portal hypertension in schistosomotic patients submitted to esophagogastric devascularization with splenectomy

BACKGROUND: The main cause of portal hypertension in Brazil is the hepato-splenic form of mansonic schistosomiasis and the most employed technique for the surgical approach of this disease is the esophagogastric devascularization with splenectomy, generally associated to postoperative endoscopical esophageal varices sclerotherapy. The hemodynamic alterations after surgical treatment and its possible influence on the outcome are not well established. AIM: To evaluate the immediate impact of esophagogastric devascularization with splenectomy upon portal pressure as well as the results of the surgical treatment on digestive hemorrhage recurrence and on esophageal varices. METHODS: Nineteen patients with mean age of 37.9 years and portal hypertension and previous episodes of digestive hemorrhage caused by esophageal varices rupture due to hepato-splenic schistosomiasis were studied. None of the patients had received any treatment prior to the surgery and underwent to elective esophagogastric devascularization with splenectomy. Portal pressure was assessed at the beginning and at the end of esophagogastric devascularization with splenectomy through portal vein catheterization with a polyethylene catheter introduced through a jejunal branch vein. All patients were submitted to digestive endoscopy before and after the surgery, in order to classify the size of esophageal varices after esophagogastric devascularization with splenectomy according to Palmer's classification. RESULTS: In all patients the portal pressure had diminished with a mean decrease of 31.3% after esophagogastric devascularization with splenectomy. In the postoperative endoscopic follow-up (1 month), the esophageal varices showed a statistically significant reduction in their size, when compared to the pre-surgical measurements. CONCLUSION: These results have demonstrated that the esophagogastric devascularization with splenectomy promotes immediate decrease in the portal pressure and a consequent reduction in the esophageal varices size. We also observed that the risk of mortality and severe complications related to this technique is not insignificant.     

Evaluation of the effects of combined endoscopic variceal ligation and splenectomy with pericardial devascularization on esophageal varices

INTRODUCTION In patients with portal hypertension, collaterals should be established to reduce the high portal pressure, and the hemodynamic indicators of such collaterals have been used for the evaluation of therapeutic effects. According to the location…     

A rat model of esophageal varices

We have developed a new method for inducing portal hypertension and esophageal varices in rats--partial ligation of the portal vein after devascularization of the circumference of the left renal vein and complete ligation of the portal vein on the fifth day thereafter. Thirty rats were separated into groups of 10, control (sham operation), complete portal ligation only and complete portal ligation plus devascularization. Two weeks after the surgery, the presence of esophageal varices in rats with complete portal ligation plus devascularization was confirmed by portography and by the histological findings. The diameter (mean +/- SD) of the submucosal veins of the lower esophagus in the complete portal ligation plus devascularization group (219.4 +/- 86.6 microns) was significantly larger than that in the complete portal ligation group (99.8 +/- 53.4 microns) or in the control group (30.5 +/- 16.6 microns) (p less than 0.01). Vascular structures of the lower esophagus closely resembled those in humans with esophageal varices. This new technique is simple, rapid and reliable, and application can be made to various experimental studies on portal hypertension.     

脾切除贲门周围血管离断术治疗晚期血吸虫病并门静脉海绵样变

目的 目的 探讨晚期血吸虫病门静脉高压症合并门静脉海绵样变的外科治疗方式。 方法 方法 对湖南省血吸虫病防治 所附属湘岳医院18例晚期血吸虫病合并门静脉海绵样变患者的临床资料进行回顾性分析。结果 结果 16例患者行脾切除贲 门周围血管离断术; 2例患者先行内镜食管曲张静脉套扎术, 后因再次食管静脉曲张破裂出血, 分别于术后32、 40个月行脾 切除贲门周围血管离断术。术后随访6～72个月, 未再发现食管胃底静脉曲张。结论 结论 脾切除贲门周围血管离断术适用 于晚期血吸虫病门静脉高压合并门静脉海绵样变的治疗。     

Splenectomy with endoscopic variceal ligation is superior to splenectomy with pericardial devascularization in treatment of portal hypertension

INTRODUCTION Recurrent bleeding occurs in over 70% of portal hypertension patients with a variceal bleeding history[1]. It is a general consensus that all patients with a variceal bleeding history should accept further treatment to prevent re-bleeding. Su…     

内镜治疗食管胃静脉曲张前后门体侧支循环的变化

目的 比较肝硬化胃食管静脉曲张(GEV)患者内镜治疗前后门体侧支循环的变化,评价内镜治疗前伴或不伴食管旁静脉曲张(Para-EV)及非静脉曲张门体分流与内镜治疗疗效的关系.方法 2007年1月至2009年12月期间在内镜中心行食管静脉曲张套扎(EVL)+胃静脉曲张组织胶注射(EBC)治疗的肝硬化食管胃静脉曲张患者26例.在治疗前1周及治疗后1年内进行64排螺旋CT门脉成像检查,观察门脉系统侧支血管在内镜治疗前后的变化情况.结果 胃左静脉平均直径在内镜治疗后显著减小[(6.7±1.9)mm比(5.0±1.9)mm,P＜0.05].治疗前GEV伴Para-EV与不伴ParaEV的内镜治疗有效率差异无统计学意义(80.0%比72.7%,P＞0.05).治疗前GEV伴非静脉曲张门体分流与不伴非静脉曲张门体分流的内镜治疗有效率差异无统计学意义(82.4%比66.7%,P＞0.05).结论 多排螺旋CT门脉成像可以为GEV的治疗方案选择及评价预后提供重要信息.     

Bleeding isolated gastric varices: a retrospective analysis.

OBJECTIVE: Isolated gastric varices (IGV) are rare and are believed to be associated with left-sided portal hypertension. We studied patients presenting with bleeding from IGV and compared them with those bleeding from both esophageal and gastric varices. METHODS: A retrospective analysis of 14 patients with bleeding from IGV was carried out. Portovenography findings (pattern of collateralization and natural shunts) in these patients were compared with a matched group of 69 patients with both esophageal and gastric varices. RESULTS: Of 14 patients with IGV, 2 had isolated splenic vein thrombosis and 12 had generalized portal hypertension. Portovenograms in 11 of the latter 12 revealed predominantly 'left-sided' collateralization in 8 patients as compared to 17 of 69 (25%) patients with esophageal and gastric varices (p = 0.004); natural shunts were seen in 6 of 11 cases and 15 of 69 (22%) patients in the two groups, respectively (p = 0.05). Abdominal devascularization operation gave good short- and long-term control of bleeding. CONCLUSIONS: Contrary to belief most patients with isolated gastric varices may have generalized portal hypertension rather than splenic vein obstruction as the cause and hence should be treated by a more extensive procedure than just splenectomy. The IGV could be a result of predominant collateralization to the retroperitoneal area (left-sided collateralization and natural shunts) rather than the usual pattern to the azygos system which results in esophageal varices.