门静脉高压症联合手术前后血流动力学变化的临床意义

目的探讨门静脉高压症患者在联合手术前后血流动力学变化的临床意义。方法回顾性分析45例脾切除、贲门周围血管离断加脾肾静脉分流(简称联合手术)患者术前、术中、术后血流动力学的变化及其对临床疗效的影响。结果本组无手术死亡。术后门静脉自由压从(37±8)cmH_2O降至(30±4)cmH_2O,两者相比差异有统计学意义(P<0.05);门静脉入肝血流量从(1098±338)ml/min减至(995±293)ml/min,两者相比差异有统计学意义(P>0.05);肠系膜上静脉血流量从(605±288)ml/min增至(735±293)ml/min,两者相比差异有统计学意义(P<0.05)。42例(93%)患者得到随访,平均随访时间2年6个月,再出血发生率为4%,其中1例死亡。门静脉高压性胃病得到明显缓解,肝性脑病发生率为4%,未发现脾静脉血栓形成,肝功能得到一定程度的改善。结论联合手术是治疗门静脉高压症较为理想的有效术式。

A combination portaazygous devascularization and splenorenal shunt for the treatment of portal hypertension: hemodynamic studies

Objective To investigate the clinical significance of hemodynamic changes of a combination portaazygous devascularization and splenorenal shunt for the treatment of portal hypertension. Methods Retrospective study was carried out in 45 patients who underwent splenectomy,pericardial devascularization and splenorenal shunt.The hemodynamic changes were measured before,during and after the combined operation.Results There was no operative mortality in this study.Postoperative free portal pressure decreased significantly (P<0.05),the hepatic blood flow in the portal vein decreased (P>0.05),and the superior mesenteric venous blood flow increased significantly (P<0.05).Postoperatively, 93% patients were followed up,the mean follow-up time was two years and six month.The rebleeding rate was 4% and one patient died during the period.The portal hypertensive gastropathy was improved obviously. The incidence of eneephalopathy was 4% and no splenic venous thrombosis was found,postoperative hepatic function improved significantly.Conclusion The combined operation is an effective therapy for the treatment of portal hypertension.