血管离断术联合经颈静脉肝内门体分流术对门静脉血流动力及肝肾功能的影响

目的分析腹腔镜贲门-胃底周围血管离断联合经颈静脉肝内门体分流术（TIPS）对肝硬化门静脉高压症效果的影响。 方法选择2016年2月至2018年2月宜宾市第二人民医院接受治疗的肝硬化门静脉高压症导致胃底食管静脉曲张患者94例，随机数字表法分成两组，各47例，其中对照组行腹腔镜贲门-胃底周围血管离断术，观察组在对照组基础上行TIPS术，观察两组患者临床疗效、实验室指标以及围手术期门静脉血流动力学。 结果（1）观察组患者总有效率为95.74%（45/47），显著高于对照组的82.98%（39/47），差异有统计学意义（Z=5.173，P=0.005）。（2）术后6个月时，观察组患者脾静脉血流量（SVF）、门体压力梯度、门静脉直径（PVD）、脾静脉内径（SVD）、门静脉血流量（PVF）较术前下降，且显著低于同期对照组水平，而脾静脉流速（SVV）及门静脉流速（PVV）较术前升高，显著高于同期对照组水平（P<0.05）。（3）术后1、6个月时，观察组患者血清尿素水平较术前下降，并显著低于同期对照组水平，而白蛋白（ALB）水平较术前上升，显著高于同期对照组水平，术后1个月观察组患者血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）水平高于术前，但低于对照组，术后6个月观察组ALT及AST水平低于术后1个月和对照组（P<0.05）。（4）术后1、6个月时，观察组患者血清内皮素（ET）、血管紧张素Ⅱ（ATⅡ）及血浆肾素活度（PRA）表达水平较术前下降，且显著低于同期对照组水平，差异有统计学意义（P<0.05）。 结论腹腔镜贲门-胃底周围血管离断联合TIPS治疗肝硬化门静脉高压导致的胃底食管静脉曲张，可显著改善患者的肝、肾功能及门静脉血流动力学。

Effect of vascular disconnection combined with transjugular intrahepatic portosystemic shunt on portalblood flow and liver and kidney function in patients with portal hypertension and gastric esophageal varices

ObjectiveTo analyze the effect of laparoscopic cardiopulmonary bypass and transjugular intrahepatic portosystemic shunt (TIPS) on cirrhotic portal hypertension. MethodsNinety-four patients with cirrhotic portal hypertension and gastric esophageal varices who were treated in the Second People’s Hospital of Yibin City from February 2016 to February 2018 were randomly divided into two groups. Patients in the control group (47 patients) underwent pericardial vascular separation, and patients in the observation group (47 cases) underwent TIPS on the basis of control group. The clinical efficacy, laboratory parameters and portal hemodynamics before and after operation were observed. Results(1) The total effective rate of the observation group was 95.74% (45/47), which was significantly higher than that of the control group (82.98%, 39/47), the difference was statistically significant (Z=5.173,P=0.005). (2) At 6 months after operation, splenic venous blood flow (SVF), portal pressure gradient, portal vein diameter (PVD), splenic vein diameter (SVD) and portal vein blood flow (PVF) of the observation group decreased compared with the preoperative level, and were significantly lower than the control group, while the splenic venous flow velocity (SVV) and portal venous flow velocity (PVV) were higher than the preoperative period, which were significantly higher than the same period, with statistically significant differences (P<0.05). (3) At1 month and 6 months after operation, the serum urea level of the observation group decreased compared with the preoperative level, and was significantly lower than the level of the control group, while the albumin (ALB) level increased. Compared with the control group, the levels of aminotransferase (ALT) and aspartate aminotransferase (AST) in the observation group were higher than those in the control group, but lower than those in the control group. The level of ALT and AST in the observation group was lower than that in the control group at 6 months after operation. There was significant difference between the control group and the observation group at 1 month after operation (P<0.05). At 1 month and 6 months after operation, the serum levels of endothelin (ET), AngiotensinⅡ(ATⅡ) and plasma renin activity (PRA) in the observation group decreased compared with preoperative period (P<0.05). ConclusionLaparoscopic cardia-vessel vascular detachment combined with TIPS can significantly improve liver and kidney function and portal hemodynamics in patients with cirrhotic portal hypertension and gastric fundus esophageal varices.