断流加分流联合术的门静脉血流动力学变化与临床疗效
作者：汪昱 郑起 冯昌宁
单位：上海市第六人民医院外科(200233)
关键词：高血压；门静脉；血流动力学；断流术；脾肾静脉分流术
外科理论与实践000217摘 要：前瞻性分析门奇静脉断流加脾肾静脉分流术(联合手术)和断流术后的门静脉血流动力学变化与临床疗效。方法：彩色多普勒超声监测各手术组门静脉系统血流动力学变化，随访临床疗效。结果：联合手术组PVD术后平均下降0.20cm(15.87%)、PVF平均下降288.29ml/min(41.15%)，FPP平均下降0.66kPa(17.41%)；断流组PVD平均下降0.13cm(9.29%)，PVF平均下降200.70ml/min(30.35%)，FPP平均下降0.38kPa(10.56%)；联合手术组与断流组比较PVD有明显差异(P<0.01)。再出血率分别为2.9%和13.8%(P<0.05)，肝性脑病率分别为5.7%和3.5%(P<0.05)。结论：联合手术组的门静脉血流动力学变化及临床疗效优于断流组。
, http://www.100md.com
Portal Hemodynamics and the Clinical Effects of Devascularization Combined with splenorenal Shunt for Portal Hypertension. Wang Yu ,Zheng Qi ,Feng Changning
(Department of Surgery，Shanghai Sixth People's Hospital，Shanghai(200233))
Abstract：To study prospectively the change in portal hemodynamics and the clinical effects of splenorenal shunt combined with porta-azygous devascularization(combined therapy)in comparison with simple portaazygous devascularization for portal hypertension.Methods：Doppler sonography was used to observe the change in portal hemodynamics and the patients of both groups were carefully followed up.Results：When compared to their corresponding pre-operative values，the portal vein diameter(PVD)was reduced 0.20cm(15.87%)，the portal vein flow(PVF)dropped 228.29ml/min(41.15%)and the free portal pressure(FPP)dropped 0.66kPa(17.41%)in the combined therapy group；while the PVD was reduced 0.13cm(9.29%)，the PVF dropped 200.70ml/min(30.35%)and the FPP dropped 0.38kPa(10.57%)in the devascularization group.The degree of change in PVD differred significantly between the two groups(P<0.01)，the respective rebleeding rate was 2.9%vs 13.8%(P<0.05)，and the rate of encephalopathy close to each other(5.7%vs 3.5%P<0.05).Conclusions：As judged from the clinical effects and the Change in portal hemodynamics，combined therapy is to be preferred than the devascularization procedure.
, http://www.100md.com
Keywords：Portal hypertension Hemodynamics Devascularization Splenorenal shunt
参考文献：
[1]宣正荣，裘法祖.门静脉高压症的血流动力学.中华外科杂志,1981,19:246.
[2]黄莛庭，范凌波.肝硬化时区域性自发性门体分流的动物试验研究.中华外科杂志,1996,34:133.
[3]Kawasaki S，Kidokoro A，Sugiura M，et al.Effects of nonshunting operations on portal venous pressure and hepatic blood flow.Am J Surg,1987,153:295.
[4]张雪峰，夏振龙，徐凤桐.超声多普勒对肝炎后肝硬变门静脉高压症血流动力学的初步研究.中华外科杂志,1993,31:213.
[5]Williams SG，Wesaby D.Management of variceal haemortage.Br Med J,1994,308:1213.
收稿日期：1999-10-27, http://www.100md.com
单位：上海市第六人民医院外科(200233)
关键词：高血压；门静脉；血流动力学；断流术；脾肾静脉分流术
外科理论与实践000217摘 要：前瞻性分析门奇静脉断流加脾肾静脉分流术(联合手术)和断流术后的门静脉血流动力学变化与临床疗效。方法：彩色多普勒超声监测各手术组门静脉系统血流动力学变化，随访临床疗效。结果：联合手术组PVD术后平均下降0.20cm(15.87%)、PVF平均下降288.29ml/min(41.15%)，FPP平均下降0.66kPa(17.41%)；断流组PVD平均下降0.13cm(9.29%)，PVF平均下降200.70ml/min(30.35%)，FPP平均下降0.38kPa(10.56%)；联合手术组与断流组比较PVD有明显差异(P<0.01)。再出血率分别为2.9%和13.8%(P<0.05)，肝性脑病率分别为5.7%和3.5%(P<0.05)。结论：联合手术组的门静脉血流动力学变化及临床疗效优于断流组。
, http://www.100md.com
Portal Hemodynamics and the Clinical Effects of Devascularization Combined with splenorenal Shunt for Portal Hypertension. Wang Yu ,Zheng Qi ,Feng Changning
(Department of Surgery，Shanghai Sixth People's Hospital，Shanghai(200233))
Abstract：To study prospectively the change in portal hemodynamics and the clinical effects of splenorenal shunt combined with porta-azygous devascularization(combined therapy)in comparison with simple portaazygous devascularization for portal hypertension.Methods：Doppler sonography was used to observe the change in portal hemodynamics and the patients of both groups were carefully followed up.Results：When compared to their corresponding pre-operative values，the portal vein diameter(PVD)was reduced 0.20cm(15.87%)，the portal vein flow(PVF)dropped 228.29ml/min(41.15%)and the free portal pressure(FPP)dropped 0.66kPa(17.41%)in the combined therapy group；while the PVD was reduced 0.13cm(9.29%)，the PVF dropped 200.70ml/min(30.35%)and the FPP dropped 0.38kPa(10.57%)in the devascularization group.The degree of change in PVD differred significantly between the two groups(P<0.01)，the respective rebleeding rate was 2.9%vs 13.8%(P<0.05)，and the rate of encephalopathy close to each other(5.7%vs 3.5%P<0.05).Conclusions：As judged from the clinical effects and the Change in portal hemodynamics，combined therapy is to be preferred than the devascularization procedure.
, http://www.100md.com
Keywords：Portal hypertension Hemodynamics Devascularization Splenorenal shunt
参考文献：
[1]宣正荣，裘法祖.门静脉高压症的血流动力学.中华外科杂志,1981,19:246.
[2]黄莛庭，范凌波.肝硬化时区域性自发性门体分流的动物试验研究.中华外科杂志,1996,34:133.
[3]Kawasaki S，Kidokoro A，Sugiura M，et al.Effects of nonshunting operations on portal venous pressure and hepatic blood flow.Am J Surg,1987,153:295.
[4]张雪峰，夏振龙，徐凤桐.超声多普勒对肝炎后肝硬变门静脉高压症血流动力学的初步研究.中华外科杂志,1993,31:213.
[5]Williams SG，Wesaby D.Management of variceal haemortage.Br Med J,1994,308:1213.
收稿日期：1999-10-27, http://www.100md.com