贲门周围壁内外双重断流术治疗门脉高压症对肝脏血流及近远期功能的影响

目的：观察贲门周围壁内外双重断流术对门静脉高压症患者近远期肝功能的影响。方法：回顾性分析1989年1月—2008年1月我院367例行贲门周围壁内外双重断流术的门静脉高压症患者手术前后门静脉的血流变化,比较术前和术后1周和1、6、12个月谷丙转氨酶（ALT）、血清胆红素（TB）、血浆总蛋白（TP）、血浆白蛋白（ALB）等肝功能指标。结果：术前平均自由门静脉压为（36.2±4.2）cmH2O,术后为（31.4±3.3）cmH2O,差异有统计学意义（P〈0.05）。术后门静脉血流速度和血流量较术前显著降低,肝动脉血流速度和血流量较术前显著升高,差异均有统计学意义（P〈0.05）。术后1、3月肝功能各指标较术前无明显改变（P〉0.05）,术后6、12月肝功能各指标较术前明显改善（P〈0.05）。结论：贲门周围壁内外双重断流术能适度降低门静脉压力,同时强化肝动脉灌注,对维持门静脉高压症患者术后近期肝功能、改善术后远期肝功能具有重要作用。

Effects of double devascularization procedure on hemodynamics and recent and long-term hepatic function of portal hypertensive patients

Objective： To investigate the effects of devascularization procedure on portal hemodynamics and recent and long-term hepatic function of portal hypertensive patients. Methods： A retrospective clinical analysis about portal hemodynamics and recent and long-term hepatic function was made in 367 cases of portal hypertensive patients, who admitted to our hospital and subjected to double devascularization from January 1989 to January 2008. Results： It was found that FPP was decreased from （36.2±4.2）cmH2O preoperatively to （31.4±3.3）cmH2O postoperatively （P0.05）. The average velocity and blood flow quantity of portal vein were decreased postoperatively, which of hepatic artery contrarily were increased significantly （P0.05）. Compared with the preoperative liver function, the postoperative liver function was no significant changes after 1 and 3 month （P0.05）, but if was improved significantly after 6 and 12 month （P0.05）. Conclusions： The double devascularization procedure can not only decrease portal vein pressure moderately but also strengthen the hepatic artery perfusion. It plays an important role on maintaining recent liver function and improving long-term liver function postoperatively.