脾动脉盗血综合征的临床研究

目的研究门静脉高压症时是否存在脾动脉盗血及手术前后肝动脉血流动力学变化,为该类患者是否行脾切除术提供依据。方法54例正常人为对照组,69例门静脉高压症患者为试验组,门静脉高压症患者均行脾切除加贲门周围血管离断术,术前根据脾功能亢进状况分为轻度脾亢组（28例）和中重度脾亢组（41例）,采用TOSHIBAaplio50型彩色多普勒超声诊断仪,清晨空腹进行检查。常规检查肝胆脾情况,测量门静脉、脾动脉及肝动脉内径、血流参数（包括平均流速V、血流量F）。结果门静脉高压组门静脉内径明显大于对照组（P〈0.05）,血流量高于对照组（P〈0.05）,平均流速低于对照组（P〈0.05）。门静脉高压组血流量较对照组降低（P〈0.05）,中重度脾亢组肝动脉血流量较对照组有明显下降（P〈0.05）。中重度脾亢组患者脾动脉内径、平均流速及血流量较对照组均有明显升高（P〈0.01）。中重度脾亢患者脾切除后肝动脉血流量明显增加（P〈0.01）。结论门静脉高压症时门静脉血流增加,肝动脉血流量减少,脾动脉血流量明显增加,中重度脾亢时存在脾动脉盗血,脾切除后肝动脉血流量明显增加。

Study on the plenic artery steal syndrome

Objective To investigate whether there exists splenic artery steal in patients with portal hypertension （PTH）, and the changes of hepatic artery hemodynamics before and after operation in order to provide the basis for whether splenectomy is done or not in such patients. Methods The clinical data of 69 PTH patients （patient group ） ineluding 28 mild hypersplenism patients and 41 moderate and severe hypersplenism patients according to the situation of hypersplenism were collected, and 54 healthy subjects were enrolled as control group. Splenectomy plus pericardial devascularization was opertated in all the patients. Doppler uhrasonography （DUS）was used to measure the diameter of portal vein, splenic artery, hepatic artery and blood flow parameters. Results In patient group the diameter of portal vein was bigger and blood flow was higher than that in control group （ P 〈 0.05 ）. The average flow rate of portal vein in patient group was slower than that in control group（ P 〈 0.05 ）. The average flow rate of hepatic artery in patient group was slower than that in control group（ P 〈 0.05 ）. The average flow rate in hepatic artery of patients with moderate and severe hypersplenism was significantly decreased, as compared with that in control group （ P 〈 0.05 ）. The average flow rate, blood flow and the diameter of splenic artery in patients with moderate and severe hypersplenism were significantly increases, as compared with those in the patients with moderate and severe hypersplenism （ P 〈 0.01 ）. The blood flow of hepatic artery increased obviously after splenectomy. Conclusion The blood flow of portal vein and splenic artery increases significantly in patients with PTH, while the blood flow of hepatic artery declines. There exists splenic artery steal in patients with moderate and severe hypersplenism. The blood flow of hepatic artery increases obviously after splenectomy.