Huet P M, Lavoie P, Légaré A, Viallet A
Yale J Biol Med. 1975 Mar;48(1):55-66.
Hemodynamic data were obtained in 13 cirrhotic patients with severe portal hypertension, undergoing combined hepatic vein, umbilicoportal vein, and superior mesenteric artery catheterization. The relative clearance of indocyanine green, the portohepatic gradient (difference between the free portal venous pressure and the free hepatic venous pressure), and the estimated hepatic blood flow were measured. The portal fraction (PF) of total hepatic blood flow was calculated in all patients using indicator dilution curves obtained from the portal bifurcation, a right hepatic vein, and when possible a left hepatic vein (six cases) after injection of (51)Cr-labeled red blood cells ((51)Cr RBC) into the superior mesenteric artery. Flows were overestimated because of loss of indicator through spontaneous portosystemic shunts; however, the ratio between hepatic and portal indicator dilution curves can be used to calculate the portal fraction of total hepatic blood flow since no extrahepatic shunts existed after the bifurcation of the portal vein (as shown on portography). In 10 patients, 15 series of curves were calculable and the PF varied between 30.1 and 100% (mean ± SE: 71.1 ± 6.2%). In the three other patients, only delayed activity from recirculation was detected from portal and hepatic vein samples and PF was 0%; in these three cases, portography and arteriography revealed spontaneous portacaval shunting with reverse and/or stagnant circulation in the portal vein. In the 13 patients, no correlation existed between PF and the relative clearance of indocyanine green or the portohepatic gradient, parameters generally used as indices of severity in cirrhosis. In 10 patients, no correlation was found between PF and the estimated hepatic blood flow.These data indicate that (51)Cr RBC dilution curves can be used for the estimation of the portal fraction of total hepatic blood flow in conscious cirrhotic patients before portacaval shunts. Using this methodology, it could be assessed whether any critical level of portal fraction exists above which poor clinical results occur after portacaval shunting. This measurement could eventually be helpful in determining the appropriate surgical procedure to be applied in individual cases.
对13例患有严重门静脉高压的肝硬化患者进行了血流动力学数据采集，这些患者同时接受了肝静脉、脐门静脉和肠系膜上动脉插管。测量了吲哚菁绿的相对清除率、肝门梯度（游离门静脉压力与游离肝静脉压力之差）以及估计的肝血流量。在所有患者中，通过将（51）铬标记的红细胞（（51）铬红细胞）注入肠系膜上动脉后，从门静脉分叉处、右肝静脉以及可能的左肝静脉（6例）获得的指示剂稀释曲线来计算全肝血流量的门静脉分数（PF）。由于指示剂通过自发性门体分流而丢失，血流量被高估；然而，由于门静脉分叉后不存在肝外分流（如门静脉造影所示），肝和门静脉指示剂稀释曲线之间的比率可用于计算全肝血流量的门静脉分数。在10例患者中，可计算出15组曲线，PF在30.1%至100%之间变化（平均值±标准误：71.1±6.2%）。在另外3例患者中，从门静脉和肝静脉样本中仅检测到再循环引起的延迟活性，PF为0%；在这3例病例中，门静脉造影和动脉造影显示存在自发性门腔分流，门静脉内有反向和/或停滞循环。在这13例患者中，PF与吲哚菁绿的相对清除率或肝门梯度之间不存在相关性，这两个参数通常用作肝硬化严重程度的指标。在10例患者中，未发现PF与估计的肝血流量之间存在相关性。这些数据表明，（51）铬红细胞稀释曲线可用于估计清醒肝硬化患者在门腔分流术前全肝血流量的门静脉分数。使用这种方法，可以评估是否存在任何关键的门静脉分数水平，高于该水平后门腔分流术后临床结果不佳。这种测量最终可能有助于确定个别病例应采用的合适手术程序。
