超声对肝豆状核变性患者脾切除前后肝脏血流变化的监测及意义

目的 应用超声检查技术了解肝豆状核变性（HLD）并发脾功能亢进症患者脾切除前后肝脏血流改变的特点。方法 使用彩色多普勒超声检测108例HLD患者在脾脏切除前后门静脉右支内径、最大血流流速、肝右动脉最大血流流速和阻力指数变化。结果 HLD患者脾切除后门静脉右支内径为（8.48±1.88）mm,与脾切除前[（9.09±2.16）mm,P>0.05]比,差异无统计学意义;脾切除后门静脉右支最大血流流速（Vmax）为（19.40±3.41）cm/s,显著低于脾切除前水平[（23.47±5.78）cm/s,P<0.01];脾切除后肝右动脉最大血流流速（PSV）为（60.71±11.85）cm/s,显著快于脾切除前水平[（40.33±8.83）cm/s,P<0.01];脾切除后肝右动脉阻力指数（RI）为（0.66±0.05）,明显高于脾切除前水平[（0.63±0.05）,P<0.01]。结论 HLD并发脾功能亢进症患者在脾切除术后门静脉系统、肝动脉系统血供发生了明显的变化,使用超声检查技术对其进行监测可为临床评估患者术后肝功能情况提供依据。

Ultrasonography in monitoring hepatic hemodynamics before and after splenectomy in patients with hepatolenticular degeneration

Objective To observe the changes of hepatic hemodynamics by ultrasonography before and after splenectomy in patients with hepatolenticular degeneration（HLD） complicated by hypersplenism. Methods 108 patients with HLD were recruited and they all received color doppler ultrasonography before and after splenectomy. The inner diameter and maximum velocity of right portal vein （Vmax）,peak systolic velocity （PSV） and resistance index（RI） of right hepatic artery were recorded and analyzed. Results The inner diameters of right portal vein before and after splenectomy were （9.09±2.16） mm and （8.48±1.88） mm,respectively（P>0.05）;Vmax of right portal vein after splenectomy declined remarkably as compared with that before splenectomy[（19.40±3.41） cm/s vs.（23.47±5.78） cm/s,P<0.01];PSV and RI of right hepatic artery after splenectomy were significantly higher than those before surgery [（60.71±11.85） cm/s vs. （40.33±8.83） cm/s and （0.66±0.05） vs. （0.63±0.05）,P<0.01 for both]. Conclusion Prominent changes in blood supply of portal venous system and hepatic artery system in patients with HLD and hypersplenism take place after splenectomy. Ultrasonography can monitor the changes of hepatic hemodynamics and provide information for the evaluation of patients' liver function.