摘要
目的：研究ＴＩＰＳＳ加改良Ｓｕｇｉｕｒａ术对门静脉高压症患者门脉循环、肝外门－体分流和肝功能的影响，评价这一联合治疗模式的临床适用性。 方法：对本组１４例门脉高压症伴食管静脉曲张患者，进行ＴＩＰＳＳ加改良Ｓｕｇ－ｉｕｒａ 术治疗前后的９９ｍ Ｔｃ 动态显像自身对比研究。 结果：术前患者的肝、门静脉开始显影时间分别为（５８．６７±１３．７１） ｓ、（５３．３３±１０．８２） ｓ；门－体分流指数（ＳＩ）为（８７．３６±６．２５）％ ；门静脉压力为（４２．８９±３．３３）ｃｍ Ｈ２Ｏ 。ＴＩＰＳＳ术后患者肝、门静脉显影时间分别提前到（４３．１１±８．４３）ｓ和（３９．５６±８．５９）ｓ（Ｐ＜ ０．０１）；ＳＩ下降为（７５．３０±６．９９）％ （Ｐ＜ ０．０１）。门静脉压力为（３４．００±２．６５）ｃｍ Ｈ２Ｏ（Ｐ＜ ０．００１）。改良Ｓｕｇｉｕｒａ术后肝、门静脉的开始显影时间又有明显降低，ＳＩ无显著变化。肝放射性－时间曲线斜率上升为４．８２±３．１７（Ｐ＜ ０．０１）。术后２ 周门静脉压力比ＴＩＰＳＳ术后明显降低。肝功能无明显改变。 结论：ＴＩＰＳＳ可降低门－体分流指数，改善门静脉血液循环；改良Ｓｕｇ－ｉｕｒａ 术会增加门静脉入?
Objectives: The purpose of this study was to determine the influences of combined TIPSS and modified Sugiura procedure on portal circulation and portasystemic shunt in patients with portal hypertension and to assess the therapeutic efficacy of this combined therapeutic protocol. Methods: Fourteen patients with portal hypertension and oesophageal varices underwent the combined treatment of TIPSS and modified Sugiura procedure and were entered into the study that included routine 99m Tc dynamic scintigraphy, direct portal venous pressure measurement. Results: The initiating developing time of liver and portal vein were brought forward from (58.67±13.71) seconds and (53.33±10.82) seconds to (43.11±8.43) seconds and (39.56±8.59) seconds( P <0.01) after TIPSS, respectively. The SI (shunt index), (87.36±6.25)% before TIPSS, decreased to (75.30±6.99)%( P <0.01). Portal pressure decreased from (42.89±3.33)cmH 2O to (34.00±2.65)cmH 2O( P <0.001). After modified Sugiura procedure, the initiating developing time of liver and portal vein moved up significantly, while SI remained no change. The average slope of hepatic time radioactivity curves increased to 4.82±3.17( P <0.01). The portal pressure decreased further more. The hepatic function did not change significantly. Conclusions: TIPSS reduces SI effectively and improves the portal circulative situations, the modified Sugiura procedure increases the portal hepatopetal blood flow, which preserves the high velocity of blood flow in intrahepatic shunt pathway. The influences of combined TIPSS and modified Sugiura procedure on portal circulation and portasystemic shunt are beneficial.And this combined protocol can reliably enhance the clinical therapeutic efficacy on portal hypertension.
出处
《医学研究生学报》
CAS
1999年第4期203-208,共6页
Journal of Medical Postgraduates
关键词
高血压
门静脉
断流术
门体分流术
外科
内支撑
Hypertension, portal
Devascularization
Portasystemic shunt, surgical
Stents
