选择性脾胃区减断分流术对肝脾血流动力学的影响

摘要

目的 探讨肝硬化门静脉高压患者行选择性脾胃区减断分流术(SDDS-GSR)后肝脾血流动力学的改变及临床意义.方法 前瞻性收集41例行SDDS-GSR术治疗患者的超声检查资料,按术前、术后2周及术后1年分为3期,并以21例正常体检患者为对照进行研究.结果 (1)脾脏厚度在术后2周(47±8)mm及术后1年(46±8)mm较术前(60±9)mm显著减小(P<0.01).(2)术后2周门静脉直径(1.13±0.19)cm较术前显著变窄(P<0.01),脾动脉直径(0.49±0.08)cm较术前显著变窄(P<0.05),肝动脉直径(0.40±0.07)cm较术前显著增宽(P<0.05).术后1年门静脉直径(0.89±0.17)cm均较术前显著变窄(P<0.01).(3)术后2周门静脉血流量(649±294)ml/min和脾动脉血流量(446±254)ml/min较术前显著减小(P<0.01),肝动脉血流量(612±295)ml/min较术前显著增加(P<0.01).术后1年肝动脉血流量(401±152)ml/min与术前和正常组比较差异均无统计学意义(P>0.05).结论 肝硬化门静脉高压症患者肝脾血流动力学参数发生异常变化;SDDS-GSR有助于纠正肝硬化门静脉高压症患者肝脾血流动力学的紊乱状态.%Objective To evaluate the changes of splanchnic hemodynamics after selective decongestive devascularization shunt of gustrosplenic region (SDDS-GSR) in the treatment of patients with portal hypertension. Methods All these 41 portal hypertensive patients underwent a combination surgery including partially occlusion of the splenic artery, Warren distal splenorenal shunt and devascularization. Postoperative patients were followed-up by ultrasonography for changes of splanchnic hemodynamics. Results were compared with that of 21 healthy volunteers. Results The thickness of spleen 2 weeks and 1 year after surgery (47±8) mm, (46±8) nun decreased from preoperative (60±9) mm (P<0.01). The diameter of portal vein (1.13±0.19) cm and splenic artery (0.49±0.08) cm 2 weeks after surgery decreased (P<0.05) and that of hepatic artery (0.40±0.07) cm increased (P<0.05). Patients' preoperative portal vein blood flow volume (1716±1262) ml/min and splenic artery (1269±570) ml/min were larger than that of normal group (P<0.05), while that of hepatic artery (321±126) ml/min was significantly less than that of normal group (P<0.05). The portal blood flow (649±294) ml/min and that of splenic artery (446±254) ml/min 2 weeks after surgery decreased significantly (P<0.01). The hepatic artery blood flow (612±295) ml/min increased significantly (P<0.01). When reevaluated at 1 year the hepatic artery blood flow (401±152) ml/min was not significantly different compared with that before surgery and that in normal group (P>0.05). Conclusions There are significant alterations in hepatic and splenic hemodynamics in patients with portal hypertension, and that SDDS-GSR can partially reverse the chaos of the hepatic and splenic hemodynamics in cirrhotic portal hypertensive patients.