摘要
应用Duplex超声(DU)术前预测合适的门体分流和直径。方法:28例于术前、10例于术中应用DU,5例于术前应用经皮肝穿刺门静脉造影术(PTP)测定门、脾静脉直径和门、脾静脉流量。根据流量公式测算吻合口直径,并严格按此直径作脾切除加脾肾静脉吻合术或肠系膜上静脉与下腔静脉侧侧吻合术。结果:脾切除术后门静脉直径预测值(15.1mm±2.2mm)与实测值(14.9mm±2.8mm)无显著差异(P>0.05)。应用DU所测的合适分流口径(10.3mm±1.03mm)与应用PTP所测值(10.49mm±1.72mm)也无显著差异。分流术毕即测得的游离门静脉压力为2.71kPa±0.31kPa,与理想水平2.64kPa无显著差异(P>0.05)。结论:应用非侵入性的Duplex超声可在术前精确地预测合适的分流口直径,使游离门静脉压降至理想水平,即既能预防再出血,又能最大限度维持向肝血流,从而减少肝性脑病的发生。
To predict the optimum diameter for portasystemic shunt by preoperative Duplex ultraso-nography. Background: Portasystemic shunts are effective in treating bleeding esophagogastric varices, but their postoperative results could vary remarkably with reliable the difference in diameters of the shunts. As far as we know, there is not yet any method to predict the optimum diameter of portasystemic shunts. Methods: The portal vein diameter (PVD), the portal volume folw(PVF), the splenic vein dia-meter(SVD) and the splenic volume flow(SVF) were determined preoperatively in 28 patients and intra-operatively in 10 patients using Duplex ultrasonography; PVD, PVF, SVD and SVF were also determined in 5 patients preoperatively using percutaneous transhepatic portography(PTP). The diameter of the shunts were calculated with the equations based on blood flow data. Conventional splenorenal shunts following splenectomy or side-to-side mesocaval shunts were performed strictly according to predeter-mined shunt diameters. Results: The predicted value(15.1mm±2.2mm) and the actual value(14.9mm±2.8 mm) of PVD after splenectomy were similar(P>0.05). The optimum shunt diameter predetermined by both Duplex ultrasonography(10.03mm±1.03mm) and by PTP(10.49mm±1.72mm) were almost the same. The free portal pressure(FPP) measured immediately after shunting was 2.71kPa±0.31kPa, attaining the ideal predicted pressure level of 2.64kPa(P>0.05). Conclusions: the optimum shunt diameter can be pre-dicted by noninvasive Duplex ultrasonography before operation; and the shunt performed accordingly would reduce, the portal pressure to such an extent that variceal hemorrhage is prevented and the hepatopetal portal blood flow maintained to the highest degree that the incidence of portasystemic en-cephalopathy(PSE) be lowered.
出处
《外科理论与实践》
1999年第2期81-83,91,共4页
Journal of Surgery Concepts & Practice
