肝硬化患者原位肝移植术后的内脏循环血流动力学变化

目的　探讨肝硬化患者背驮式原位肝移植 (PBOLT)术后 1年内内脏循环血流动力学变化。方法　 15例因肝硬化行PBOLT患者 ,分别于术前和术后 1～ 3d ,7～ 15d ,3～ 6个月 ,1年应用彩色多普勒血流显像仪 (CDFI)测定门静脉血流平均流速 (PBV)、门静脉血流量 (PBF)、肝动脉搏动指数 (HA PI)、脾动脉阻力指数 (SA RI)、脾脏纵向直径 (LDS)、肠系膜上动脉搏动指数 (SMA PI)等血流动力学指标 ,并与 10例正常人进行对照。结果　PBV ,HA PI ,SA RI等血流动力学指标在肝移植术后 1年内基本恢复正常 ( P >0 .0 5 ) ;LDS明显缩小 ,但仍高于正常值 ;PBF于术后 1年仍较正常对照值高 ( P<0 .0 5 ) ;SMA PI于术后 1年较术前有所恢复 ,但仍低于正常对照值 (P <0 .0 5 )。结论　肝硬化患者的内脏循环血流动力学紊乱在原位肝移植 1年内绝大部分得到恢复。说明肝移植术本身并不导致术后高血流动力学的发生 ,肝硬化患者肝移植后的早期内脏血流动力学紊乱可能与移植前已存在的病理生理因素有关

Splanchnic hemodynamic changes after liver transplantation for patients with cirrhosis

Objective To investigate the long-term splanchnic hemodynamic changes after piggy-back(orthotopic)(liver) transplantation( PBOLT)for patients with cirrhosis .Methods In 15 cirrhotic patients undergoing OLT ,the following parameters were measured before surgery and subsequently at 1-3days,7-15days,3-6months and 1year after operation by using color Doppler flow imaging(CDFI): Portal blood flow mean velocity(PBV),Portal blood flow(volume)(PBF),hepatic artery pulsatility index(HA-PI),splenic artery resistance index(SA-RI) and spleen size(LDS),superior mesenteric artery pulsatility index(SMA-PI).The same parameters were measured in 10 healthy controls.Results PBV,HA-PI and SA-RI returned to normal value 1 years after OLD.LDS decreased(significantly), but persisted to be larger than that in controls(P>0.05). PBF was still increased more then normal values 1 years after OLT(P<0.05). SMA-PI increased slightly after operation,but (remained) at lower values than that in control(P<0.05).Conclusions Most splanchnic hemodynamic parameters of(cirrhosis) are restored to normal(after) PBOLT within 1 year. The results demonstrated that splanchnic hyperkinetic abnormalities seen in early liver(transplantation) may result from the pretransplant pathophysiologic status in cirrhotic patients ,and that(splanchnic)(hyperhemodynamics) is not induced by OLT per se.