脾切除贲门周围血管离断术后肝脏血流动力学和储备功能的变化

Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascuiarization. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. The HAF (hepatic artery flow), PVF (portal venours flow) and hepatic arterial RI(resistant index) were measured with Doppler sonography. The EHBF(effective hepatic blood flow) and ICGR15 (indocyaninegreen retention rate at 15 minutes) were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy (19±4) mm Hg, ligating the splenic artery(14±4) mm Hg, splenectomy(14±3)mm Hg and periesophagogastric devascularization (12±4) mm Hg showed a tendency to decrease progressively. The PVF decreased [from (42±14) ml/s to (16±8) ml/s] and HAF increased in compensation after operation. The EHBF increased [from (0.48±0.10) L/min to (0.56±0.10) L/min], and the ICGR15 decreased (from 23%±8% to 18%±4%) postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.     

脾切除贲门周围血管离断术后肝脏血流动力学和储备功能的变化

Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascuiarization. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. The HAF (hepatic artery flow), PVF (portal venours flow) and hepatic arterial RI(resistant index) were measured with Doppler sonography. The EHBF(effective hepatic blood flow) and ICGR15 (indocyaninegreen retention rate at 15 minutes) were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy (19±4) mm Hg, ligating the splenic artery(14±4) mm Hg, splenectomy(14±3)mm Hg and periesophagogastric devascularization (12±4) mm Hg showed a tendency to decrease progressively. The PVF decreased [from (42±14) ml/s to (16±8) ml/s] and HAF increased in compensation after operation. The EHBF increased [from (0.48±0.10) L/min to (0.56±0.10) L/min], and the ICGR15 decreased (from 23%±8% to 18%±4%) postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.     

脾切除贲门周围血管离断术后肝脏血流动力学和储备功能的变化

Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascuiarization. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. The HAF (hepatic artery flow), PVF (portal venours flow) and hepatic arterial RI(resistant index) were measured with Doppler sonography. The EHBF(effective hepatic blood flow) and ICGR15 (indocyaninegreen retention rate at 15 minutes) were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy (19±4) mm Hg, ligating the splenic artery(14±4) mm Hg, splenectomy(14±3)mm Hg and periesophagogastric devascularization (12±4) mm Hg showed a tendency to decrease progressively. The PVF decreased [from (42±14) ml/s to (16±8) ml/s] and HAF increased in compensation after operation. The EHBF increased [from (0.48±0.10) L/min to (0.56±0.10) L/min], and the ICGR15 decreased (from 23%±8% to 18%±4%) postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.     

脾切除贲门周围血管离断术后肝脏血流动力学和储备功能的变化

Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascuiarization. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. The HAF (hepatic artery flow), PVF (portal venours flow) and hepatic arterial RI(resistant index) were measured with Doppler sonography. The EHBF(effective hepatic blood flow) and ICGR15 (indocyaninegreen retention rate at 15 minutes) were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy (19±4) mm Hg, ligating the splenic artery(14±4) mm Hg, splenectomy(14±3)mm Hg and periesophagogastric devascularization (12±4) mm Hg showed a tendency to decrease progressively. The PVF decreased [from (42±14) ml/s to (16±8) ml/s] and HAF increased in compensation after operation. The EHBF increased [from (0.48±0.10) L/min to (0.56±0.10) L/min], and the ICGR15 decreased (from 23%±8% to 18%±4%) postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.     

血清GP73在肝脏肿瘤中的表达及意义

在Kladney研究发现组织中高尔基糖蛋白73(Golgi protein73,GP73)与肝炎、肝硬化、肝癌有相关性后,有学者认为GP73很可能成为诊断肝癌的新标志物~([1-4]).本研究初步探讨GP73在肝脏良恶性肿瘤患者的血清GP73的定量表达水平.     

脾切除贲门周围血管离断术后肝脏血流动力学和储备功能的变化

目的 研究脾切除贲门周围血管离断术后肝脏血流动力学及肝功能储备的变化.方法 对2006年6月至2007年8月在四川大学华西医院行脾切除贲门周围血管离断术的连续30例乙肝后肝硬化患者通过感应器连续测定手术中的门静脉压力梯度;运用彩色多普勒分别测最术前和术后肝动脉血流量、门静脉血流量、肝动脉阻力指数,通过术前和术后吲哚青绿试验分别测得有效肝血流量及ICGR15.结果 本组30例患者的门静脉压力梯度在开腹后为(19±4)mm Hg,结扎脾动脉后为(14±4)mm Hg,脾切除后为(14±3)mm Hg,贲门周围血管离断术后为(12±4)mm Hg,有逐渐下降的趋势.术后门静脉血流餐由(42±14)ml/s降至(16±8)ml/s,而肝动脉血流量代偿性增加.术后有效肝血流量由(0.48±0.10)L/min增至(0.56±0.10)L/min,而ICGR15由22%±8%减至18%±4%.结论 脾切除贲门周围血管离断术后,尽管门静脉压力梯度及门静脉血流量减少,但肝功能储备至少在术后短期内是得到了改善的.     

脾切除贲门周围血管离断术后肝脏血流动力学和储备功能的变化

Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascuiarization. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. The HAF (hepatic artery flow), PVF (portal venours flow) and hepatic arterial RI(resistant index) were measured with Doppler sonography. The EHBF(effective hepatic blood flow) and ICGR15 (indocyaninegreen retention rate at 15 minutes) were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy (19±4) mm Hg, ligating the splenic artery(14±4) mm Hg, splenectomy(14±3)mm Hg and periesophagogastric devascularization (12±4) mm Hg showed a tendency to decrease progressively. The PVF decreased [from (42±14) ml/s to (16±8) ml/s] and HAF increased in compensation after operation. The EHBF increased [from (0.48±0.10) L/min to (0.56±0.10) L/min], and the ICGR15 decreased (from 23%±8% to 18%±4%) postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.     

脾切除贲门周围血管离断术后肝脏血流动力学和储备功能的变化

Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascuiarization. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. The HAF (hepatic artery flow), PVF (portal venours flow) and hepatic arterial RI(resistant index) were measured with Doppler sonography. The EHBF(effective hepatic blood flow) and ICGR15 (indocyaninegreen retention rate at 15 minutes) were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy (19±4) mm Hg, ligating the splenic artery(14±4) mm Hg, splenectomy(14±3)mm Hg and periesophagogastric devascularization (12±4) mm Hg showed a tendency to decrease progressively. The PVF decreased [from (42±14) ml/s to (16±8) ml/s] and HAF increased in compensation after operation. The EHBF increased [from (0.48±0.10) L/min to (0.56±0.10) L/min], and the ICGR15 decreased (from 23%±8% to 18%±4%) postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.     

脾切除贲门周围血管离断术后肝脏血流动力学和储备功能的变化

Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascuiarization. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. The HAF (hepatic artery flow), PVF (portal venours flow) and hepatic arterial RI(resistant index) were measured with Doppler sonography. The EHBF(effective hepatic blood flow) and ICGR15 (indocyaninegreen retention rate at 15 minutes) were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy (19±4) mm Hg, ligating the splenic artery(14±4) mm Hg, splenectomy(14±3)mm Hg and periesophagogastric devascularization (12±4) mm Hg showed a tendency to decrease progressively. The PVF decreased [from (42±14) ml/s to (16±8) ml/s] and HAF increased in compensation after operation. The EHBF increased [from (0.48±0.10) L/min to (0.56±0.10) L/min], and the ICGR15 decreased (from 23%±8% to 18%±4%) postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.     

术前门静脉血流速度在门静脉高压症断流术后血栓形成中的预测价值

目的 评价术前门静脉血流速度对乙型肝炎肝硬化门静脉高压症断流术后门静脉血栓形成(PVT)中的预测价值.方法 对2007年1月至2008年7月在四川大学华西医院同一外科小组行脾切除和断流术的连续45例乙型肝炎后肝硬化门静脉高压症患者,运用彩色多普勒超声测量术前1 d门静脉直径、流速以及术后7 d有无门静脉系统血栓形成.同时计算患者术前Child-Pugh评分.术后测量去脾脏血液后的脾脏重量,检测术前1 d、术后7 d凝血酶原时间(PT)和血小板计数(PLT).并将患者分为血栓组与非血栓组、高速组与低速组,分别对上述指标进行统计学对比分析.结果 术后发生门静脉系统血栓13例(28.9%),血栓组(n=13)术前门静脉流速为(19.5±5.3)cm/s,其中12例低于25 cm/s[平均(18.4±3.8)cm/s],1例为32.3 cm/s;非血栓组(n=32)术前门静脉流速为(29.6±8.0)cm/s,两组差异有统计学意义(P<0.01).低速组(n=17)和高速组(n=28)血栓发生率分别为70.6%和3.6%,差异有统计学意义(P<0.01).分别比较两种分组的患者术前Child-Pugh评分、脾脏重量、手术前后PT和PLT,差异均无统计学意义(P>0.05).25 cm/s作为指标预测术后血栓形成的敏感性为92.3%,特异性为70.6%.结论 术前门静脉直径增加及血流速度降低是导致术后门静脉系统发生血栓的主要危险因素,尤其当门静脉流速降低(<25 cm/s)时,断流术后血栓发生率将显著增高.门静脉直径与血流速度存在负相关系,可根据门静脉流速预测门静脉高压症断流术后的血栓的形成.