快速补流对门静脉血液动力学的影响

探讨急性失血性休克，对肝硬门静脉高压犬门静脉系统血流动力学，和快速补液对门静脉压力等指标恢复的影响。方法肝硬化门脉高压犬模型造成急性ＨＳ，并于ＨＳ后给予快速补液抗休克，插管直接测定门静脉压力、平均动力脉压、肝脏血流量。结论：肝硬化ＨＳ后，快速补液后ＰＶＰ会早于ＭＡＰ迅速升高并超过休克前水平，ＰＶＰ达到正常水平时所需补液明显小于失血量。     

肝移植与门静脉高压症

本文就肝移植与肝炎后肝硬变门静脉高压症 (以下称门静脉高压症 )的有关问题结合文献作如下复习。一、门静脉高压症肝移植治疗的指征与禁忌证肝移植的指征是肝病患者存在危及生命和影响病人生活质量的并发症的Child PughC级的病人 ,这些并发症包括肝性脑病、食管静脉曲张出血、顽固性腹水和严重的营养不良等。肝性脑病的生存质量很差 ,手术或曲张静脉硬化剂注射治疗不能改善病人的情况甚至加重脑病的表现 ;腹水是晚期肝病伴门静脉高压症病人的表现 ,顽固性腹水、反复的自发性腹膜炎的病人寿命很少超过 1年 ,患者需要反复放腹水缓解症状。…     

肝动脉、门静脉双重插管化疗在中晚期肝癌治疗中的体会

随着肝癌诊断率的提高和手术方法的改进，我国肝癌5年生存率在不断上升。但临床上碰到的已属于中晚期原发性肝癌，或合并转移性肝癌，手术的切除率不高。我院自1999年1月至2003年11月共行原发性肝癌手术60例．其中16例不能切除的肝癌均采用肝动脉、门静脉同时插管，间断灌注化疗，效果尚满意，现报告如下。     

门奇静脉断流加XF折叠缝合胃底术治疗门静脉高压症28例

笔者回顾性分析采用门奇静脉断流加XF折叠缝合胃底术治疗28例门静脉高压症患者的治疗效果。28例中术后发生并发症8例（28.6%)，均经非手术疗法治愈；全组无手术死亡。27例（96.4%)经 4~49个月随访，结果示胃底食管曲张静脉消失率为81.5%，术后再出血率14.3%，肝功能明显改善，远期并发症少。提示门奇断流加XF折叠缝合胃底术治疗门静脉高压症食管胃底静脉曲张疗效满意。     

谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

远端脾腔分流术治疗门静脉高压症65例疗效分析

1988年10月～2004年10月我们采用远端脾腔分流术(distal splenoeaval shunt，DSCS)治疗肝炎肝硬变门静脉高压症64例，血吸虫肝硬变门静脉高压症1例，共65例。经多年临床实践．手术方法不断改进和完善，治疗效果亦不断提高。本文就65例DSCS的手术效果和治疗经验报道如下。     

门静脉高压症内脏血管扩张机制的研究进展

内脏高动力循环在门静脉高压发病机制中起着重要作用。而内脏血管的扩张在内脏高动力循环状态的形成中起着关键作用,其确切机制至今尚未完全阐明。本文综述了近年来对肝硬化门静脉高压症内脏血管扩张机制的研究进展。     

肝硬化门脉高压病人的预后

探讨肝硬化门脉高压病人的预后具有重要的临床意义。研究表明,不同病因预后各异,出现腹水后预后较差;根据静脉曲张程度、范围、压力及粘膜色泽可预测出血或再出血;门脉压力、肝脏血流及肝脏组织学改变与预后密切相关,血清 TSB、白蛋白、PT、胆酸、FN 和 LPS 等是较好的肝功能预后指环;肝功能的分级和判别模型的建立最有预测预后的价值。     

全植入式药泵行肝血管灌注治疗晚期肝癌

对２４例不能切除的晚期肝癌采用完全植入式药泵行肝动脉和门静脉双灌注化疗。结果：部分缓解（ＰＲ）１５例（６２．５％），稳定（Ｓ）８例（３３．３％），进展（Ｐ）１例。平均生存期为９．１７月，半年生存率为６６．７％，１年为２５％。在ＡＦＰ＞４００μｇ／Ｌ的１０例中，５例下降。