介入性門脈斷流術對門靜脈血流動力學的影響

趙春紅 季良

摘要：目的? 觀察介入性門脈斷流術對門靜脈血流動力學指標的影響。方法? 選取2018年1月～2019年1月在我院治療的60例乙肝肝硬化因食管胃底靜脈曲張出血合并脾功亢進患者為研究對象，均采用胃冠狀靜脈栓塞加部分脾栓塞術治療，比較治療前后自由門靜脈壓（FPP）及門靜脈及脾靜脈介入術后6周門靜脈（PV）和脾靜脈（SV）的血流動力學指標（內徑、平均血流速度、血流量）。結果? 胃冠狀靜脈栓塞術后FPP（42.61±5.02）cmH2O高于術前（37.01±4.22）cmH2O，差異有統計學意義（P<0.05），聯合部分脾栓塞術后FPP（36.03±5.44）cmH2O下降，與胃冠狀靜脈栓塞術后比較，差異有統計學意義（P<0.05），但與術前比較， 差異無統計學意義（P>0.05）;術后6周PV內徑、平均血流速度、血流量與術前比較，差異無統計學意義（P>0.05）;SV內徑、平均血流速度、血流量均小于術前，差異有統計學意義（P<0.05）。結論? 胃冠狀靜脈栓塞術會引起門靜脈壓力升高，但聯合部分脾栓塞術后FPP會降低，且不影響門靜脈血流動力學變化，對臨床合理選擇治療方式具有重要的指導意義。

關鍵詞：介入性;門脈斷流術;門靜脈;血流動力學指標

中圖分類號：R575.2? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻標識碼：A? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2020.08.033

文章編號：1006-1959（2020）08-0108-02

Abstract：Objective? To observe the influence of interventional portal vein devascularization on portal hemodynamics.Methods? 60 patients with hepatitis B cirrhosis due to esophagogastric varices bleeding and hypersplenism treated in our hospital from January 2018 to January 2019 were selected as the research subjects. All patients were treated with gastric coronary vein embolization plus partial splenic embolization. Before and after treatment， free portal vein pressure （FPP） and hemodynamic indicators （internal diameter， average blood flow velocity， blood flow） of portal vein （PV） and splenic vein （SV） 6 weeks after portal vein and splenic vein intervention.Results? The FPP （42.61±5.02） cmH2O after gastric coronary embolization was higher than that before （37.01±4.22） cmH2O， the difference was statistically significant （P<0.05）， and the FPP （36.03±5.44） cmH2O decreased after combined partial splenic embolization. Compared with postoperative gastric coronary embolism， the difference was statistically significant（P<0.05）， but compared with preoperatively， the difference was not statistically significant（P>0.05）; There was no statistically significant difference in PV inner diameter， average blood flow velocity and blood flow compared with preoperative 6 weeks after surgery（P>0.05）; SV inner diameter， average blood flow velocity and blood flow were less than before surgery， the difference was statistically significant（P<0.05）.Conclusion? Gastric coronary vein embolization can cause increased portal vein pressure， but FPP will decrease after combined partial splenic embolization， and it will not affect the hemodynamic changes of the portal vein. It has important guiding significance for the rational choice of clinical treatment.