脾肾分流联合断流术治疗门静脉高压症的效果及对血流动力学的影响

目的:探讨脾切除脾肾静脉分流加断流术(联合术)和单纯断流术的临床疗效及对门静脉血流动力学的影响.方法:对联合组11例、断流组18例运用彩色多普勒超声(DCFI)、间接门静脉造影(IPVG)、磁共振门脉血管成像(MRPVG)以及术中自由门静脉压(FPP)的测定,观察两种手术对门静脉系统血流动力学的影响及近期疗效.结果:MRPVG测得的PV和SV的血流量与DCFI测得的结果间差异无显著性.MRPVG对门静脉系统的成像效果好.断流组PV流量减少(417.48±239.37)ml/min,联合组减少(457.30±227.43)ml/min,两者间无显著差异.断流组FPP降低(3.83±1.73)mmHg,联合组降低(5.49±4.51)mmHg,联合组降压效果明显优于断流组.结论:MRPVG应作为PHT首选检查手段.联合术切断了门奇间反常的血流侧支,在降低FPP的同时又能保持一定的肝脏门静脉血流灌注,临床疗效满意,有望成为门静脉高压症的首选术式.

Prospective comparison of splenorenal shunt combined with pericardial devascularization versus pericardial devascularization

Objective:To investigate the clinical and hemodynamic effects of two operative procedures:splenorenal shunt combined with pericardial devascularization and pericardial devascularization.Methods:Two procedures were employed in 29 cases of portal hypertension. The change of hemodynamics of the portal venous system and clinical result were studied by doppler colour flow imagine(DCFI),indirect portal venography(IPVG),magnetic resonance portal venography(MRPVG) and free portal pressure(FPP) during operation.Results:There was no significant difference between the values derived from MRPVG and DCFI. The anatomical imaging of the portal venous system could be more clearly revealed in MRPVG. Both operative procedures could significantly decrease the portal flow,but there was no difference between them in statistics. The portal pressure after combined therapy was decreased more than that after pericardial devascularization.Conclusion:MRPVG should become the routine examination in evaluation and follow-up of portal hypertension cases. The combined procedure cuts off the abnormal collateral shunts,decreases the FPP;meanwhile,it also maintains liver perfusion. Thus,the clinical result is satisfying. The combined procedure hopes to be a preferred operation in the treatment of portal hypertension.