肝纤维化程度的门静脉及脾脏血流动力学评价

一、资料与方法１．对象：北京友谊医院住院患者４６例。其中慢性肝炎３７例,肝硬化９例,平均年龄（３．０２±１２．３０）岁,住院期间行肝脏活组织检查。另选本院肝胆外科住院行门静脉分流手术的肝硬化患者１８例,平均年龄（４６．３１±１０．１１）岁,术中取肝脏活组织检查。２．方法：采用东芝ＳＳＡ-２７０彩超,探头频率为３．ＳＭＨｚ在肝活检或手术前２日空腹检查,将脉冲多普勒的取样框置于待测血管的中央,保持声束与血流的夹角０°～６０°,测量时间平均血流速度（ＴＡＶ）,血管的截面积、内径宽度,以ＴＡＶ与截面积的…     

门静脉高压脾切除术后门静脉血栓形成防治

<正>目前治疗门静脉高压的主要手术方式为脾切除加贲门周围血管离断术,此术式能有效消除脾功能亢进、有效止血,并对肝脏功能有较小的影响,且术后肝性脑病和肝衰竭发生率相对较低。但脾切除加贲门周围血管离断术仍发生各种并发症,门静脉血栓形成(PVT)是术后主要并发症之一。PVT国外发生率为0.5%²2%〔1〕。国内术后PVT发生率8.5%22%〔1〕。国内术后PVT发生率8.5%³1.8%〔231.8%〔2⁴〕。PVT症状多表现为上腹疼痛、腹泻、发热等,不具     

生长抑素对肝癌患者肝叶切除术后血浆蛋白合成及创伤修复的影响

目的探讨肝细胞癌(HCC)患者肝叶切除术后早期使用生长抑素对血浆蛋白合成及创伤修复的影响。方法19例HCC患者行不规则肝叶/肝段切除术。其中9例术后早期皮下注射8肽生长抑素0.1mg/4h,连续3天;另10例未使用生长抑素。结果两组拆线时间和胆漏的发生率无明显差别(P>0.05),但使用生长抑素组腹腔引流量明显少于对照组(P<0.05)。术后1、3、5天,两组患者血浆ALB、PA和PTA水平无显著差异(P>0.05)。结论术后早期使用生长抑素有助于减少并发症的发生,对创伤的愈合及肝脏合成蛋白无影响,不会引发肝功能失衡。     

肝硬化门静脉高压患者门静脉压力与血流动力学的关系

通过多普勒超声技术，检测肝硬化门静脉高压患者门静脉系统血流动力学状态并分析其与门静脉压力的关系，旨在探讨多普勒超声技术对肝硬化门静脉高压患者门静压力的诊断意义。     

生长抑素对肝癌切除术后患者肝功能及病情的影响

目的探讨生长抑素（SS）对肝癌切除术后患者肝功能及病情的影响。方法将21例肝癌伴肝硬化患者分为两组,均行肝癌切除术;治疗组术后给予SS治疗,对照组不予SS治疗。观察两组术后腹腔引流量、肝功能变化及平均住院时间。结果两组术后均未发生上消化道出血;与对照组比较,治疗组术后第3．5、7天腹腔引流量明显减少,肝功能明显改善,住院时间明显缩短（P均〈0．05）。结论SS具有减轻肝切除术后肝功能损害作用,对肝癌伴肝硬化患者术后有一定应用价值。     

门静脉高压患者门静脉压力与血流动力学的相关性研究

目的 探讨门静脉高压患者门静脉血流动力学的变化特点及其与门静脉压力的相互关系。方法 采用彩色多普勒超声对４１例肝硬化门静脉高压患者（Ｃｈｉｌｄ Ａ、Ｂ级３１例、Ｃ级１０例）于手术前检测门静脉（ＰＶ）、脾静脉（ＳＶ）和肠系膜上静脉（ＳＭＶ）的内径和血流速度，再计算出相关的面积和血流量；于手术时对３１例ＣｈｉｌｄＡ十Ｂ级患者直接测量门静脉压力。３２例健康人和２６例慢性乙型肝炎患者（慢肝组）作为对照。结累 门静脉高压两组患者ＰＶ、ＳＶ和ＳＭＶ内径（ｃｍ）分别为１．５１和１．５２、１．３２和１．３４及１．１５和１．１５较慢肝组和正常组明显增宽，ｒ分别为１．３１和１．１６、０．９６和０．７９及０．９１和０．８２（Ｐ＜０．０１）；血流速度较正常组和慢肝组明显减慢（Ｐ＜０．０１）；门静脉高压Ｃ级组门静脉血流速度（ｃｍ／ｓ）为４．６５较门静脉高压Ａ十Ｂ级组（６．４２）明显减慢（Ｐ＜０．０１），而两组 ＳＶ和 ＳＭＶ的血流速度则差异无显著意义（Ｐ＞０．０５）；门静脉高压 Ａ＋Ｂ级组三条静脉的血流量明显大于正常组和慢肝组（Ｐ＜０．０１或Ｐ＜０．０５）；门静脉高压Ｃ级组门静脉血流量明显小于Ａ十Ｂ级组（Ｐ＜０．０１）；而ＳＶ和ＳＭＶ的血流     

肝动脉门静脉化疗对门静脉压力的影响

肝动脉门静脉化疗(hepatic artery and portal vein chemotherapy,HAPVC)是目前肝癌治疗的重要方法之一[1].但HAPVC是否将造成术后自由门静脉压力(free portal pressure,FPP)变化?变化规律怎样?化疗后上消化道出血是否与FPP的升高有关?我们就此问题探讨如下.     

DMN诱发鼠肝纤维化过程中肝门静脉压力的变化

本文通过模型大鼠门脉压力的测定 ,观察二甲基亚硝胺(ＤＭＮ )诱发大鼠肝硬化过程中门脉压力的动态变化以及与肝纤维化关系。材料与方法一、材料Ｗｉｓｔａｒ雄性大鼠 ,体重 14 0～ 15 0 ｇ ,购自中科院上海实验动物中心。ＤＭＮ购自瑞典威灵公司。ＰＴ14ＭＸ 4ｋＰａ生理压力传感器购自复旦大学传感器工程研究室。二、模型制备将 0 .5 %ＤＭＮ溶液按 0 .2ｍｌ/10 0 ｇ体重剂量予大鼠腹腔注射 ,每周连续注射 3ｄ ,共 4周 ,第 1周用 2 /3量 ,以后用全量。共设 10个观察组 ,分别是 2ｄ ,1、2、3、4、5、6、8、12和 2 4周。每组设正常对照鼠 3…     

生长抑素对肝硬化病人门脉血流动力学的影响

生长抑素对肝硬化病人门脉血流动力学的影响刘菲，陆玮，倪玮彩色双功超声仪用于检测门脉血流动力学包括血管内径、流速、血流量，对区分正常肝、慢性肝炎、肝硬化及肝脏肿瘤有较大意义，并能评估血管活性药物对肝硬化门脉血流动力学的影响。我们于１９９４年５月至１９９...     

加味瓜蒌散对门静脉高压症大鼠门静脉压力与肝纤维化指标的影响

目的:观察加味瓜蒌散对门脉高压大鼠门静脉压力、肝纤维化指标的影响。方法:采用M ed lab-Ug4Cs生物信号采集处理系统、放免法,检测正常组、模型组、心得安对照组、加味瓜蒌散治疗组大鼠门静脉压力、肝纤维化指标。结果:模型组大鼠门静脉压力较正常组明显升高(P<0.01),加味瓜蒌散各剂量组、心得安对照组大鼠门脉压力较模型组明显下降(P<0.01),加味瓜蒌散各剂量组大鼠门脉压力与心得安治疗组比较,差异无显著性意义(P>0.05)。加味瓜蒌散各剂量组大鼠Ⅳ-C、PCⅢ、HA、LN与模型组比较均明显下降(P<0.01或P<0.05);而心得安组大鼠Ⅳ-C、PCⅢ、LN与模型组比较,差异无显著性意义(P>0.05),而HA明显升高(P<0.05)。结论:加味瓜蒌散能有效降低门静脉压力,在改善肝纤维化指标方面优于心得安。其作用机制可能与其良好的抗肝纤维化、阻止肝硬化形成、降低门脉压力、改善肝功能的作用有关。     

Effects of portal vein embolization before major hepatectomy

BACKGROUND/AIMS: Major hepatectomy can now be successfully performed after portal vein embolization, but the effects of portal vein embolization have not been clearly delineated. Our objective is to examine whether portal vein embolization really contributes to the success of major hepatectomy. METHODOLOGY: Thirty-eight patients underwent portal vein embolization and hepatectomy of two subsegments or more. They all belonged to a high-risk group according to a prognostic score. We selected 9 of 38 patients with liver metastases (PE-meta group) and 32 patients who had undergone hepatectomy without portal vein embolization (non-PE-meta group) during the study period to compare the serum levels of total bilirubin after hepatectomy. Fifteen of 38 patients had the levels of polymorphonuclear leukocyte elastase and thrombin-antithrombin complex examined after hepatectomy (PE group) and so did 20 patients without portal vein embolization (non-PE group). RESULTS: The maximum levels of total bilirubin in non-PE-meta group correlated with the percentage of hepatic parenchyma to be resected. In the patients receiving portal vein embolization, the pre-PE and post-PE levels were both below the regression. Similar shifts were seen in the graphs of polymorphonuclear leukocyte elastase and thrombin-antithrombin complex. CONCLUSIONS: The effects of preoperative portal vein embolization on safety in major hepatectomy were proved by its suppression of rise in total bilirubin, polymorphonuclear leukocyte elastase and thrombin-antithrombin complex after hepatectomy.     

门静脉动脉化对肝硬化犬肝切除后肝再生的作用

目的: 探讨门静脉动脉化( portal vein arterialization, PVA)对肝硬化犬肝切除后肝再生的作用, 为扩大PVA临床应用提供依据.方法: 将肝硬化模型犬随机分为3组, A组(手术组): 行肝左外叶切除加门静脉动脉化手术;B组(对照组): 仅行肝左外叶切除手术;C组(假手术组);均于术后4 wk处死, 实验过程中检测肝脏再生率(SE)与动脉血酮体比(AKBR), 免疫组织化学法检测增殖细胞核抗原(PCNA).结果: 肝脏再生率SE值A组显著高于B组, 两者有显著性差异(86.6%±2.9% vs 73.7%±6.9%, P<0.01);术后A、B两组AKBR值均较C组降低(均P<0.01), 术后4 wk A组该值(1.32±0.14)已接近C组(1.33±0.11), 差异无统计学意义P>0.05;术后PCNA表达A组显著快于B组.结论: 门静脉动脉化对肝硬化犬部分肝切除后肝脏再生有明显的促进作用.     

Effects of somatostatin on splanchnic hemodynamics in cirrhotic patients with portal hypertension

INTRODUCTION Esophageal variceal bleeding (EVB) is one of the most common complications of cirrhosis with portal hypertension. In recent years, great progress has been made in medicinal treatment. Somatostatin has been widely used in clinics, for it can effectively lower the portal venous pressure (PVP) with little side effect. The aim of this study is to assess the effect of somatostatin on portal venous pressue and splanchnic hemodynamics in patients with liver cirrhosis and portal hypertension.     

Portal vein thrombosis after right hepatectomy: impact of portal vein resection and morphological changes of the portal vein

BackgroundRight hepatectomy occasionally requires portal vein resection (PVR) and causes postoperative portal vein thrombosis (PVT).MethodsA total of 247 patients who underwent right hepatectomy were evaluated using a three-dimensional analyzer to identify the morphologic changes in the portal vein (PV). The patients' characteristics were compared between the PVR group (n = 73) and non-PVR group (n = 174), and risk factors for PVT were investigated. The PVR group were subdivided into the wedge resection (WR) group (n = 38) and segmental resection (SR) group (n= 35).ResultsPostoperative PVT occurred in 20 patients (8.1%). Multivariate analyses in all patients revealed that postoperative left PV diameter/main PV diameter (L/M ratio) <0.56 (odds ratio [OR] 4.00, p = 0.009) and PVR (OR 3.31, p = 0.031) were significant risk factors for PVT. In 73 patients who underwent PVR, PVT occurred in 14 (19%) and WR (OR 11.5, p = 0.005) and L/M ratio <0.56 (OR 5.51, p = 0.016) were significant risk factors for PVT.ConclusionPVR was one of the significant risk factors for PVT after right hepatectomy. SR rather than WR may be recommended for preventing PVT.     

Effects of losartan,somatostatin and losartan plus somatostatin on portal hemodynamics and renal functions in cirrhosis

BACKGROUND/AIMS: Several drugs have been used to reduce portal hypertension. Losartan constitutes arteriolar and venous vasodilation by inhibiting the effects of the increased angiotensin II in cirrhotic patients. In this study, we analyzed the effects of losartan, when used alone and when combined with somatostatin, on portal and renal hemodynamics. METHODOLOGY: Seventeen patients with cirrhosis were enrolled. During the study, the patients were administered 250 micrograms of somatostatin i.v. bolus and subsequent infusion at a rate of 250 micrograms/hr for 2 hours on the second day; 25 mg losartan orally on the fourth day; and losartan and somatostatin together, in the same doses as the second and the fourth day, were given on the sixth day. RESULTS: The portal flow volume and the velocity that were measured after the administration of somatostatin, losartan and the combination of each drug, were found to be increased when compared with the initial values (P < 0.001). Additionally, the creatinine clearances were increased and statistically significant with somatostatin. CONCLUSIONS: Considering its low cost, easy usability, long lasting effect, we suggest that losartan can be used as an alternative treatment in the clinical conditions where portal pressure should be reduced and can be combined with somatostatin without any significant adverse effects.     

Mechanistic insights of rapid liver regeneration after associating liver partition and portal vein ligation for stage hepatectomy

AIM To highlight the potential mechanisms of regeneration in the Associating Liver Partition and Portal vein ligation for Stage hepatectomy models(clinical and experimental) that could unlock the myth behind the extraordinary capability of the liver for regeneration,which would help in designing new therapeutic options for the regenerative drive in difficult setup,such as chronic liver diseases. Associating Liver Partition and Portal vein ligation for Stage hepatectomy has been recently advocated to induce rapid future liver remnant hypertrophy that significantly shortens the time for the second stage hepatectomy. The introduction of Associating Liver Partition and Portal vein ligation for Stage hepatectomy in the surgical armamentarium of therapeutic tools for liver surgeons represented a real breakthrough in the history of liver surgery. METHODS A comprehensive literature review of Associating Liver Partition and Portal vein ligation for Stage hepatectomy and its utility in liver regeneration is performed. RESULTS Liver regeneration after Associating Liver Partition and Portal vein ligation for Stage hepatectomy is a combination of portal flow changes and parenchymal transection that generate a systematic response inducing hepatocyte proliferation and remodeling. CONCLUSION Associating Liver Partition and Portal vein ligation for Stage hepatectomy represents a real breakthrough in the history of liver surgery because it offers rapid liver regeneration potential that facilitate resection of liver tumors that were previously though unresectable. The jury is still out though in terms of safety,efficacy and oncological outcomes. As far as Associating Liver Partition and Portal vein ligation for Stage hepatectomy-induced liver regeneration is concerned,further research on the field should focus on the role of nonparenchymal cells in liver regeneration as well as on the effect of Associating Liver Partition and Portal vein ligation for Stage hepatectomy in liver regeneration in the setup of parenchymal liver disease.     

Effects of sustained-release lanreotide on hemodynamics in rats with portal vein stenosis.

BACKGROUND/AIMS: Somatostatin and its analogue have been shown to provide beneficial effects in the management of portal hypertension and hyperdynamic circulation. The current study was undertaken to evaluate the effects of lanreotide, a sustained-release somatostatin analogue, on hemodynamics in rats with portal hypertension. METHODS: Immediately after portal vein stenosis, rats were randomly assigned to receive vehicle or a single intramuscular injection of lanreotide 10 mg/kg. Hemodynamic measurements (radioactive microsphere technique) with portal systemic shunts determinations were performed on the 4th and 8th day after surgery, respectively. RESULTS: On the 4th day after surgery, rats treated with lanreotide had significantly lower cardiac index and higher systemic vascular resistance than rats treated with vehicle, while these values were no different on the 8th day after portal vein stenosis. In contrast, the elevation of portal pressure, portal tributary blood flow, and splanchnic fraction of cardiac output had ameliorated following lanreotide administration associated with an increase in splanchnic arterial resistance. Portal systemic shunts were lower in rats receiving lanreotide than in rats receiving vehicle. CONCLUSION: The current study showed that a single injection of sustained-release lanreotide in rats with portal vein stenosis delayed the development of peripheral arterial vasodilatation and hyperdynamic circulation, while it modified the evolution of portal hypertension and splanchnic hyperemia. This treatment also prevents, in part, the development of portal systemic shunts in rats with portal vein stenosis.     

Effects of somatostatin analog on splanchnic hemodynamics and plasma glucagon level in portal hypertensive rats

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Preoperative hepatic hemodynamics in the prediction of early portal vein thrombosis after liver transplantation in pediatric patients with biliary atresia

BACKGROUND: Portal vein thrombosis(PVT) is one of the main vascular complications after liver transplantation(LT)especially in pediatric patients with biliary atresia(BA). This study aimed to assess the preoperative hepatic hemodynamics in pediatric patients with BA using Doppler ultrasound and determine whether ultrasonographic parameters may predict early PVT after LT.METHODS: One hundred and twenty-eight pediatric patients with BA younger than 3 years of age underwent Doppler ultrasound within seven days before LT, between October 2006 and June 2013. The preoperative hepatic hemodynamic parameters were then compared between patients with early PVT(within 1 month following LT) and those without PVT. Receiver operating characteristic analysis was performed to determine the optimal cutoff value for predicting early PVT.RESULTS: Of the 128 transplant recipients, 41(32.03%) had a hypoplastic portal vein(PV), 52(40.63%) had hepatofugal PV flow and 40(31.25%) had a high hepatic artery resistance index(HARI) of ≥1. Nine cases(7.03%) experienced early PVT. A PV diameter ≤4 mm(sensitivity 88.89%, specificity 72.27%), and a hepatofugal PV flow(sensitivity 77.78%, specificity 62.18%)with a high HARI ≥1(sensitivity 77.78%, specificity 72.27%)were hepatic hemodynamic risk factors for early PVT.CONCLUSIONS: Hepatic hemodynamic disturbances in pediatric recipients with BA were more common. Small PV diameter(≤?4 mm) and hepatofugal PV flow combined with high HARI(≥1) are strong warning signs of early PVT after LT in pediatric patients with BA. Intense monitoring of vascular patency and prophylactic thrombolytic therapy should be considered in pediatric patients undergoing LT for BA.