离断胰腺后段曲张静脉对自由门静脉压的影响

目的探讨离断门静脉高压症患者胰腺后段曲张静脉（胰腺后段腹膜后静脉和腹膜后交通支）对自由门静脉压的影响。方法回顾性分析1997年1月至2007年12月陕西省人民医院收治的135例接受小口径脾腔静脉分流联合贲门周围血管离断术的门静脉高压症患者的临床资料，其中60例在游离胰体尾离断胰腺后段曲张静脉前后测量自由门静脉压。36例有腹膜后静脉及腹膜后交通支曲张（曲张组），24例无腹膜后静脉及腹膜后交通支曲张（无曲张组）。不同时段自由门静脉压的比较采用配对t检验，组间比较采用独立样本t检验。结果135例患者腹膜后静脉及腹膜后交通支曲张发生率为68．1％（92／135），其中Ⅰ、Ⅱ、Ⅲ型分别占73．9％（68／92）、6．5％（6／92）和19．6％（18／92）。曲张组患者离断胰腺后段曲张静脉后平均自由门静脉压为（36．5±2．1）cmH20（1cmH：O=0．098kPa），显著高于离断前的（34．1±2．0）cmH20（t=4．97，P〈0．05），也显著高于无曲张组患者的（33．3±2．6）cmH20（t=5．25，P〈0．05）。结论门静脉高压症患者胰腺后段静脉曲张发生率较高，离断后可小幅升高自由门静脉压。

Impact of devascularization of postpancreatic varices on free portal pressure of patients with portal hyper-tension

Objective To investigate the impact of devascularization of postpancreatic varices on free portal pressure （FPP） of patients with portal hypertension. Methods The clinical data of 135 patients with portal hypertension who received splenocaval shunt ＋ devascularization of postpancreatic varices at the Shaanxi Provincial People＇s Hospital from January 1997 to December 2007 were retrospectively analyzed. The changes of FPP of 60 patients before and after devascularization of postpancreatic varices were detected. The 60 patients were divided into variceal group （36 patients ） and non-variceal group （24 patients ）. The FPP of varieeal group at different time points was compared by using the t test, and the difference in FPP between the 2 groups was compared by using the independent samples t test. Results The incidence of varices of retroperitoneal and collateral veins was 68.1% （92/135） , and patients with types Ⅰ , Ⅱ , and Ⅲ were accounted for 73.9% （68/92）, 6.5% （6/92） and 19.6% （18/92） , respectively. After devascularization of the postpancreatic varices, the FPP of the variceal group was （ 36.5 ± 2.1 ） cm H20 （ 1 cm H20 = 0. 098 kPa） , which was significantly higher than （ 34.1 ± 2. O） cm H20 before devascularization （ t = 4. 97, P 〈 0.05 ） and （33.3 ± 2.6） cm H20 of the non-variceal group （ t = 5.25, P 〈 O. 05 ）. Conclusions The incidence of varices of postpancreatic veins is high. Devaseularization of these variceal veins could increase the FPP.