断流加分流联合术的门静脉血流动力学变化与临床疗效

目的：前瞻性分析门奇静脉断流加脾肾静脉分流术（联合手术）和断流术后的门静脉血流动力学变化与临床疗效。方 法：彩色多普勒超声监测各手术组门静脉系统血流动力学变化，随访临床疗效。结果：联合手术组ＰＶＤ术后平均下降０．２０ ｃｍ（１５．８７％）、ＰＶＦ平均下降２８８．２９ｍｌ／ｍｉｎ（４１．１５％），ＦＰＰ平均Ｆ降０．６６ｋＰａ（１７.４１％）；断流组ＰＶＤ平均下降０．１３ｃｍ（９．２９％）， ＰＶＦ平均下降２００．７０ｍｌ／ｍｉｎ（３０．３５％），ＦＰＰ平均下降０．３８ｋＰａ（１０．５６％）；联合手术组与断流组比较ＰＶＤ有明显差异（Ｐ＜ ０．０１）。再出血率分别为２.９％和１３．８％（Ｐ＜０.０５），肝性脑病率分别为５．７％和３.５％（Ｐ＜０．０５）。结论：联合手术组的门静脉血 流动力学变化及临床疗效优于断流组。

Portal Hemodynamics and the Clinical Effects of Devascularization Combined with splenorenal Shunt for Portal Hypertension

To study prospectively the change in portal hemodynamics and the clinical effects of splenorenal shunt combined with porta-azygous devascularization (combined therapy) in comparison with simple porta- azygous devascularization for portal hypertension. Methods: Doppler sonography was used to observe the change in portal hemodynamics and the patients of both groups were carefully followed up. Results: When compared to their corresponding pre-operative values, the portal vein diameter(PVD) was reduced 0.20cm (15.87%), the portal vein flow(PVF) dropped 228.29ml/min(41.15%) and the free portal pressure(FPP) dropped 0.66kpa(17.41%) in the combined therapy group; while the PVD was reduced 0.13cm(9.29%), the PVF dropped 200.70ml/min(30.35%) and the FPP dropped 0.38kPa(10.57%) in the devascularization group. The degree of change in PVD differred significantly between the two groups(P<0.01), the respective rebleeding rate was 2.9% vs 13.8%(P<0.05), and the rate of encephalopathy close to each other(5.7% vs 3.5%,P<0.05). Conclusions: As judged from the clinical effects and the change in portal hemodynamics, combined therapy is to be preferred than the devascularization procedure.