L'Hherminé C, Paris J C, Villoutreix H, Dehaene L, Lemaitre G
J Radiol Electrol Med Nucl. 1975 Jun-Jul;56(6-7):491-503.
Spontaneous reversal of intra-hepatic portal flow in cirrhoses appears to be best demonstrated by arteriography, which shows a direct sign, i.e. retrograde opacification of intra-hepatic portal branches during selective hepate arteriography, and an indirect sign, i.e. the appearance of functional amputation of these same portal branches at the time of superior mesenteric venous return. Reversal of portal flow is sometimes complete (5 out of 15 cases), the flow being entirely away from the liver and sometimes incomplete (10 out of 15 cases), limited to the interior of the liver, portal flow then being bidirectional. Reflux of arterial blood in the intra-hepatic portal branches via the development of intra-hepatic arterioportal communications appears to be the determining factor in the reversal of portal flow in cirrhosis. The degree of portal flow away from the liver seems to depend essentially upon the extent of development of porto-caval anastomoses. Certain features suggest that there is a relationship between the development of the hepatic arterial circulation and that of the porto-caval anastomoses. These two elements which determine the degree of portl hypertension may mutually influence each other. This hypothesis is interesting in the context of understanding the haemodynamic abnormalities of advanced cirrhosis.
肝硬化时肝内门静脉血流的自发逆转似乎最好通过动脉造影来显示，动脉造影显示出一个直接征象，即在选择性肝动脉造影期间肝内门静脉分支的逆行显影，以及一个间接征象，即在肠系膜上静脉回流时这些相同门静脉分支出现功能性截断。门静脉血流逆转有时是完全的（15例中有5例），血流完全背离肝脏，有时是不完全的（15例中有10例），仅限于肝脏内部，此时门静脉血流呈双向。肝内动脉门静脉交通的发展导致肝内门静脉分支出现动脉血反流，这似乎是肝硬化门静脉血流逆转的决定性因素。门静脉血流背离肝脏的程度似乎主要取决于门腔静脉吻合支的发展程度。某些特征表明肝动脉循环的发展与门腔静脉吻合支的发展之间存在关联。这两个决定门静脉高压程度的因素可能相互影响。在理解晚期肝硬化的血流动力学异常的背景下，这一假说很有意思。
