Mineta Sho, Yoshida Hiroshi, Mamada Yasuhiro, Taniai Nobuhiko, Mizuguchi Yoshiaki, Akimaru Koho, Kumita Shin-ichiro, Kumazaki Tatsuo, Tajiri Takashi
First Department of Surgery, Nippon Medical School, Tokyo, Japan.
Hepatogastroenterology. 2005 Sep-Oct;52(65):1313-9.
BACKGROUND/AIMS: The aim of this study is to prove the hemodynamic change in distribution of splenic venous flow in the liver, especially in the cirrhotic liver, and to reveal and evaluate a participation of splenic venous flow in regeneration or enlargement of the hepatic lobe.
We studied the distribution of splenic venous flow in the liver of patients with normal liver (NL group, n=15), chronic hepatitis (CH group, n=8), and liver cirrhosis (LC group, n=13) with the technique of scintiphotosplenoportography after percutaneous intrasplenic injection of Technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin. The index of splenic venous flow volume per unit hepatocytes (Vunit) was calculated in each hepatic lobe. To compare V value of the left lobe (VLunit) with that of the right lobe (VRunit), predominant index of the left lobe (L/R index) was defined as L/R index = VLunit/VRunit.
The median (interquartile range) of L/R index of the LC group; 1.22 (1.06-1.70) was significantly higher than that of the NL group; 0.83 (0.66-0.92), p<0.001 and the CH group; 0.79 (0.69-0.92), p<0.001.
L/R index reflects the change of portal hemodynamics in cirrhotic liver and is useful for discrimination between noncirrhosis and cirrhosis. These results suggest that in the liver exposed to continuous damages, splenic venous blood promotes liver fibrosis in the right lobe and eventually flows more into the left lobe with milder fibrosis.
背景/目的：本研究旨在证实肝脏中脾静脉血流分布的血流动力学变化，尤其是在肝硬化肝脏中，并揭示和评估脾静脉血流在肝叶再生或增大中的作用。
我们采用经皮脾内注射99m锝-二乙三胺五乙酸-半乳糖基人血清白蛋白后进行脾门静脉闪烁造影技术，研究了正常肝脏患者（NL组，n = 15）、慢性肝炎患者（CH组，n = 8）和肝硬化患者（LC组，n = 13）肝脏中脾静脉血流的分布情况。计算每个肝叶中单位肝细胞的脾静脉血流量指数（Vunit）。为比较左叶（VLunit）和右叶（VRunit）的V值，将左叶的优势指数（L/R指数）定义为L/R指数 = VLunit/VRunit。
LC组L/R指数的中位数（四分位间距）为1.22（1.06 - 1.70），显著高于NL组的0.83（0.66 - 0.92），p < 0.001，也高于CH组的0.79（0.69 - 0.92），p < 0.001。
L/R指数反映了肝硬化肝脏门静脉血流动力学的变化，有助于鉴别非肝硬化和肝硬化。这些结果表明，在持续受损的肝脏中，脾静脉血促进右叶肝纤维化，最终更多地流入纤维化较轻的左叶。
