PACS手术和传统SRS、PCDV手术治疗门脉高压症的比较

目的:对丝线栓塞性门脉高压模型犬进行PACS手术和传统SRS手术、PCDV手术,分别观察不同术式对门静脉血流动力学的影响。方法:制备门脉高压动物模型;PCDV组实施脾切除、贲门周围血管离断术;SRS组实施脾切除,远端脾肾分流术。PACS组实施脾切除、门静脉-脾动脉吻合、门静脉-腔静脉吻合。彩色多普勒超声测量手术前后的入肝门脉血流、压力、入下腔门脉血流、压力;门静脉、肠系膜上静脉的内径、最大血流速度、血流方向、门静脉侧支循环和血栓形成情况,术中动态测量门静脉压(PVP)。结果:PCDV组术后门静脉流量(PVF)下降17%,PVP下降5%,门静脉血栓发生率为37%;SRS组术后PVF下降51%,PVP下降50%;PACS术后向肝PVF上升至原来的180%,向肝PVP上升至原来的196%,门静脉入下腔门脉血流量增至原来的130%,门静脉入下腔门脉压力保持低压,约为原来的45.5%,相对于传统手术SRS或PCDV的门脉PVF和PVP治疗结果均具有极为显著的统计学差异(P<0.05,P<0.01)。结论:PCDV术后门静脉高压瘀血状态并无明显改善,胃粘膜瘀血加重,复发曲张静脉破裂出血的威胁依然存在;SRS术后PVF减少和PVP均有显著性下降,门静脉血流量进一步减少,肝脏血供术后仍然受到很大影响;PACS手术成功率较高,手术死亡率等同SRS手术,可同时提高入肝血流和降低侧支压力,是一种值得尝试和进一步研究的新手术方法。

The therapeutic difference of hemodynamic changes among those portal hypertension dogs accepted PACS, PCDV and SRS operation

Objective: In order to solve the problem of the decreased portal inflow,decreased metabolic function and dangerous varicosis in portal hypertension,portal arterialization and complete shunt(PACS) was applied in the treatment of canine model of portal hypertension,which was made by thread embolization in the portal vein.At the same time,traditional operations such as PCDV and SRS were also applied in comparison.Methods: The preparation of canine model.Group PCDV accepted a splenectomy and peripheral cardia divided vessel(PCDV),while the group SRS accepted a spleen-renal vein shunt.Group PACS accepted a splenectomy,splenic artery and upper portal anastomosis,and complete portalcaval shunt.The blood pressure and flow of the portal system were observed.Results: In the PCDV group,the postoperative PVF decreased in 17% while PVP decrease in 5%,the incidence of portal thrombus was 37%.In the SRS group,the postoperative PVF decreased in 51% while PVP decrease in 50%.In the PACS group,the postoperative hepatic inflow PVF increased to 180% of the former while PVP increase to 196%;the caval-inflow PVF increased to 130% of the former while PVP decrease to 45.5%.The results of PACS group have a magnificent statistic difference comparing with those two traditional operations.Conclusion: PCDV made no difference in the treatment of portal hypertension and congestion of portal system.The dangerous rebleeding was still threatening the life because of severer gastric varicosis.SRS extraordinarily decreased the PVF and PVP,while decreased the hepatic inflow at the same time.PACS can significantly increase the hepatic inflow and decreased the blood pressure of the portal system with a pleasant dog survival.It may be a worthy attempt in the treatment of portal hypertension and need more research work.