TIPSS术后肾脏血流动力学改变的超声评价

目的　探讨经颈静脉肝内门 -体静脉分流术 (TIPSS)术后肾脏血流动力学改变及超声评价的价值。方法　应用超声技术检测并分别比较肝硬化腹水患者 (含肝肾综合征 )和肝硬化无腹水患者 TIPSS术前及术后 1周的肾脏血流动力学改变 ,同时测定并分别比较两组患者相应时相点肾功能情况。结果　肝硬化腹水患者术后 1周肾脏多普勒能量图显示较术前各级动脉血流信号明显增多 ,部分患者皮质血流得以显示 ,肾血流量 (V)较术前明显增加 (P<0 .0 1) ,肾血流阻力指数 (RI)较术前明显减小 (P<0 .0 1) ,血清肌酐 (Cr)、血清尿素氮(BUN)也较术前减少 (P<0 .0 1)。而肝硬化无腹水患者肾脏血流动力学以及肾功能各项指标手术前后无明显改变。结论　 TIPSS手术可明显改善肝硬化腹水患者肾血流灌注和肾功能 ,并可成为治疗肝肾综合征 (HRS)的有效手段 ,而对于肝硬化无腹水患者的肾血流动力学及肾功能则无明显影响。超声检测可客观地评价这些变化

Ultrasonographic Study on Renal Hemodynamic Changes after Transjugular Intrahepatic Portosystemic Stent Shunt

Objective To evaluate the renal hemodynamic changes after transjugular intrahepatic portosystemic stent shunt(TIPSS) with ultrasonography.Methods The renal hemodynamic changes one week after TIPSS in patients with ascites or without ascites were observed with ultrasonography and compared respectively with those before TIPSS,as well as the BUN(blood urea nitrogen) and Cr.Results We found no significant differences in renal blood flow and renal function before and one week after TIPSS in patients without ascites.However,the renal arterial inflow one week after TIPSS in patients with ascites was markedly increased than those before TIPSS(P<0.01) and the resistance index of renal artery,BUN and Cr after TIPSS were significantly decreased(P<0.01).Conclusions The renal hemodynamics in patients with ascites was markedly improved after TIPSS,but there were no changes in patients without ascites.The renal hemodynamic changes can be objectively detected with ultrasonography.