干旱区生态环境知识资源中心(Arid): 脾大部切除及食管横断吻合术治疗肝硬化门静脉高压症的血流动力学研究

Arid

	脾大部切除及食管横断吻合术治疗肝硬化门静脉高压症的血流动力学研究
其他题名	Portal veinous hemodynamics after subtotal splenectomy and portaazygous devascularization
	霍景山 1; 陈积圣 2; 吴卓 2; 陈汝福 2; 庄志浩 1; 区庆嘉 2
来源期刊	中华普通外科杂志
ISSN	1007-631X
出版年	2010
卷号	25 期号:1 页码:20-23
中文摘要	目的评价脾大部切除、残脾腹膜后包埋及食管横断吻合术对肝硬化门静脉高压症患者门静脉血流动力学的影响.方法将40例门静脉高压症患者随机分为研究组和对照组,每组 20例.均进行食管横断吻合术,对照组做全脾切除,研究组保留部分带血管蒂脾脏移植于腹膜后.手术前后用三维动态增强磁共振血管成像测量门静脉主干的管腔横截面面积、血流量、血流速度和流向; 观察自体移植脾在腹膜后的血供及侧支循环.结果两组术前均存在胃底食管曲张静脉,术后 6个月MRA复查均消失或改善.术后6个月两组门静脉主干的管腔横截面积明显减少[研究组 (1.810.73) cm~2比(1. 200.52) cm~2,P<0. 01; 对照组(1.780.52) cm~2比(1. 300.12) cm~2, P <0.01]; 术后两组门静脉主干的平均流速均下降[研究组(9.860.10)cm/s比(7.06 1. 92) cm/s,P<0.01; 对照组(10.00.6)cm/s比(8.22.4)cm/s,P<0.01],且研究组少于对照组 (P<0.01); 术后两组门静脉主干的平均流量均下降[研究组(15.01.9)ml/s比(10.52.7)ml/s, P<0. 01; 对照组(14.92.1)ml/s比(11.62. 1)ml/s,P<0.01],且研究组少于对照组(P<0.05).移植脾在腹膜后成活,并建立了广泛的侧支循环.结论脾大部切除、带血管蒂残脾腹膜后移植及食管横断吻合术治疗肝硬化门静脉高压症不仅保留了脾脏的功能,而且具有断流和分流为一体的联合性术式的作用
英文摘要	Objective To evaluate perioperative portal hemodynamic alterations in cirrhotic patients undergoing; subtotal splenectomy, pedicled spleen remnant retroperitoneal transplantation plus lower e sophagus transection in the treatment of portal hypertension. Method Forty patients with cirrhotic portal hyertension were randomly allocated int0 2 groups: splenic transplantation group (n = 20), in which patients underwent subtotal splenectomy with pedicled remnant spleen retroperitoneal transplantation and cardia-esophageal. devascularization and transection, and control group (n= 20), in which splenectomy and cardia-esophageal devascularization and transection were performed. The cross section area, blood velocity arid flow and collateral circulation of portal parameters were comparatively evaluated by 3D DEC MRA, and the size of remnant spleen, blood flow and collateral circulation of retroperitoneal transplanted spleen were comparatively assessed. Results At 6-month after operation, the disappearance of esophageal-gastric varices in two groups was similar, and the cross section areas of main portal vein (MPV) in two groups all decreased postoperatively, in study group it was (1. 810. 73) cm~2 vs. (1.200.52) cm~2,P<0.01;in control group it was (1.780.52) cm~2 vs.(1.30 0.12) cm~2,P<0.01.The mean blood velocity of MPV decreased postoperatively, in study group it was (9.860.10) cm/s vs. (7.06 1.92) cm/s, P < 0. 01 ; In control group it was (10. 00. 6) cm/s vs. (8. 22. 4) cm/s, P < 0. 01. The mean blood flow velocity of MPV in study group was lower postoperatively than that in control group(P < 0. 01). The mean blood flow volume of MPV decreased postoperatively from (15. 01. 9) ml/s to (10.52.7)ml/s, P < 0. 01 in study group; and from (14.92.1) ml/s to (11.62.1) ml/s, P < 0. 01 in control group. The mean blood flow volume of MPV in study group was lower postoperatively than that in control group(P<0.05).A significant collateral formation was observed around the retroperitoneally translocated pedicled remnant spleen. Conclusions Compared with splenectomy, subtotal splenectomy, retroperitoneal translocation of the pedicled remnant speen helps to preserve splenic function as well as to increase retroperitoneal collateral formation which is conducive to further decreasing the portal veinous pressure
中文关键词	高血压,门静脉 ; 脾切除术 ; 吻合术,外科 ; 器官移植 ; 血流动力学
英文关键词	Hypertension, portal Splenectomy Anastomosis, surgical Organ transplantation Hemodynamics
语种	中文
国家	中国
收录类别	CSCD
WOS类目	SURGERY
WOS研究方向	Surgery
CSCD记录号	CSCD:4087256
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/226093
作者单位	1.佛山市中医院普外科, 广东 528000, 中国; 2.中山大学孙逸仙纪念医院普外科
推荐引用方式 GB/T 7714	霍景山,陈积圣,吴卓,等. 脾大部切除及食管横断吻合术治疗肝硬化门静脉高压症的血流动力学研究[J],2010,25(1):20-23.
APA	霍景山,陈积圣,吴卓,陈汝福,庄志浩,&区庆嘉.(2010).脾大部切除及食管横断吻合术治疗肝硬化门静脉高压症的血流动力学研究.中华普通外科杂志,25(1),20-23.
MLA	霍景山,et al."脾大部切除及食管横断吻合术治疗肝硬化门静脉高压症的血流动力学研究".中华普通外科杂志 25.1(2010):20-23.