摘要
目的探讨脾脏体积大小与门静脉系统高动力循环状态及手术前后门静脉体循环分流率,血流动力学变化的关系。方法利用彩色多普勒复合装置、CT 及公式法测量22例肝硬变门静脉高压症行脾切除、贲门周围血管离断术(下简称门静脉奇静脉断流术)患者的血流动力学变化参数、脾体积及门静脉体循环分流率。结果 (1)门静脉血流量(PVF):对照组为785±144ml/min;实验组为966±125ml/min(t=3.56,P=0.002)。其中实验组的脾静脉血流量/门静脉血流量(SVF/PVF)为77%±17%,实验组的肠系膜上静脉血流量/门静脉血流量(SMVF/PVF)为28%±8%。(2)脾体积与脾静脉血流量、流速、直径显著相关(r=0.793,P<0.001,r=0.471,P<0.05,r=0.494,P<0.02).(3)术后 PVF 减少187±87ml/min,SMVF 增加100±40ml/min,门静脉体循环分流率减少26%±15%。结论门静脉高压症时,门静脉系统处于高动力循环状态,对门静脉高压的形成和维持有重要意义。脾脏的高动力循环是门静脉系统产生高动力循环的主要因素。门静脉奇静脉断流术后、门静脉血流量的变化取决于术前脾脏的高动力循环状态,胃脾区的分流程度及术后肠系膜上静脉的代偿能力。
Objective To study the relationship between the splenic volume and the hyperhemodynamics,portosys- temic shunt in patients with portal hypertension.Method The hemodynamic parameters,splenic volume and portosystemic shunting were measured with ultrasonic Doppler instrument,CT and formula method in patients with portal hypertension secondary to liver cirrhosis.Results It was found that the hyperdynamic state in portal system played an important role in the onset and maintenance of portal hypertension.The hyperdynamic circula- tion of the spleen was the main factor to cause the hyperdynamic circulation in entire portal system.Conclusion The splenic volume could indirectly reflect splenic hyperdynamic state.After portaazygous disconnection, the changes of portal flow depended on the three factors:the hyperdynamic state of spleen,portal systemic shunting degree of the stomach-spleen area and the compensatory ability of the superior mesenteric vein.
出处
《中华普通外科杂志》
CSCD
1998年第2期88-90,共3页
Chinese Journal of General Surgery
