脾肾静脉分流联合断流术的临床疗效及对门静脉系统血流动力学的影响.doc

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1、脾肾静脉分流联合断流术的临床疗效及对门静脉系统血流动力学的影响作者：孙勇伟陈炜罗蒙吴志勇周鸿张军峰顾磊【摘要】目的评价近端脾肾静脉分流加门奇断流联合手术和门奇断流术的临床疗效及对门静脉系统血流动力学的影响。方法回顾性总结近8年采用脾肾分流加门奇断流联合手术和门奇断流术治疗门静脉高压症245例，于术前一周和术后2周应用核磁共振血管造影测量门静脉、脾静脉和肠系膜上静脉的直径，流速和流量，并于术中动态测量门静脉压力。结果联合手术组术后较术前门静脉血流量下降，肠系膜上静脉流量增加，差异有统计学意义(P＜0.05)，门静脉直径和自由门静脉压下降差

2、异有统计学意义(P＜0.01)。联合手术组与断流组相比，门静脉血流量的减少差异没有统计学意义，而自由门静脉压的下降差异有统计学意义(P＜0.01)。联合手术组术后再出血率明显低于断流组，而肝功能和脑病发生率两组间差异无统计学意义。结论联合手术可结合断流和分流手术的优点，既明显降低出血率又不增加脑病发生，应成为治疗门静脉高压症合并出血的首选术式。【关键词】门静脉高压症脾肾静脉分流术断流术血流动力学【Abstract】ObjectiveToinvestigatetheclinicaleffectsofpericardialdevascula

3、rization(PCDV)andproximalsplenorenalshunt(PSRS)combinedwithPCDVandevaluaterespectivelytheireffectsonhemodynamicsofportalvenoussystem.MethodsAretrospectiveanalysiswascarriedoutin245caseswithportalhypertensiontreatedwithPCDV(PCDVgroup)orPSRSplusPCDV(combinationgroup).Thed

4、iameter,bloodflowvelocityandbloodflowofportalvein,splenicveinandsuperiormesentericveinweremeasuredbymagneticresonanceangiographat1weekpreoperativelyandat2weekpostoperatively.Freeportalpressure(FPP)wascontinuouslydeterminedduringoperation.ResultsIncombinationgroup,thebloo

5、dflowofportalveindecreasedandthatofsuperiormesentericveinincreased(P＜0.05),butthediameterofportalveinandFPPdecreasedverysignificantly(P＜0.01)comparedwiththepreoperativedata.Therewasnosignificantdifferenceupondecreaseofbloodflowofportalveinbutverysignificantdifferenceupon

6、decreaseofFPPbetweencombinationgroupandPCDVgroup(P＜0.01).PostoperativeincidencerateofrebleedingincombinationgroupwassignificantlylowerthanthatinPCDVgroup(P＜0.01).Whiletherewasnosignificantdifferenceuponliverfunctionandincidencerateofpostoperativehepaticencephalopathybetw

7、eenbothgroups.ConclusionsPSRSplusPCDVshouldbethetreatmentofchoicefortreatmentofportalhypertensioncombinedwithhemorrhagebecauseitintegrates5advantagesofshuntanddevascularization,significantlydecreasesincidencerateofrebleedingandavoidsincreaseofhepaticencephalopathy.【Keywo

8、rds】Portalhypertension;Splenorenalshunt;Devascularization;Hemodynamics门静脉高压症(PHT)并发食管胃底静脉曲张出血的治疗有两种基本术