选择性脾胃区减断分流术后血流动力学变化的实验研究

目的 研究门静脉高压症犬行选择性脾胃区减断分流术(selective decongestive devascular-ization shunt of gastrosplenic region,SDDS-GSR)后血流动力学变化.方法 用正常犬制备门静脉高压脾亢模型并进行SDDS-GSR术.制模前、成模后,分流术后30 d和术后60 d观察门静脉压力,门静脉、肝动脉、脾静脉和脾动脉的内径、血流速度和血流量参数的变化,作自身对照研究.结果 SDDS-GSR术后30 d的脾胃区静脉压力显著下降(P<0.01),门静脉、脾动脉和脾静脉内径显著缩小(P<0.01),门静脉、脾动脉和脾静脉血流量参数减少(P<0.01),肝动脉内径和血流量参数显著增加(P<0.01),术后60 d上述指标改变仍保持稳定.结论 sDDS-GSR术通过减少脾动脉血流和改善脾静脉回流,有效地降低了脾胃区的静脉压力,并保持肠系膜区的相对高压,同时增加肝动脉向肝血流量,保证了门脉的向肝血流量,术后血流动力学变化较持久稳定,是一种合理而可取的治疗门静脉高压症的术式.

Hemodynamic changes after selective decongestive devascularizatien shunt of gastrosplenic region in portal hypertension dogs

Objective To study the changes of hemodynamics after selective decongestive devas-cularization shunt of gastrosplenic region (SDDS-GSR) for treatment of portal hypertensive dogs. Methods SDDS-GSR were performed on portal hypertensive dogs. The portal venous pressure, he-modynamic parameters of portal vein, hepatic artery, spleen artery and vein were measured regularly. Results In 30 days after SDDS-GSR, the venous pressure in the gastrosplenic area decreased obvious-ly (P<0.01). Compared with those preoperative values, the parameters of blood flow in portal vein, splenic artery and vein markedly reduced (P<0.01) and the inner diameters of aforesaid vessels were narrowed (P<0.01), while the inner diameter and the parameters of blood flow in hepatic artery in-creased (P<0.01). In 60 days after the operation, the changes of aforesaid parameters were still sig-nificant as compared with those preoperative values (P<0. 01). Conclusion SDDS-GSR can decrease the venous pressure in the gastrosplenic area significantly while maintain portal perfusion by reducing the parameters of blood flow in splenic artery and ameliorating the resistance splenic vein blood cur-rent. It is reasonable and reliable for surgical management of portal hypertension.