Takenaka H, Nakao K, Miyata M, Nakahara M, Nagaoka M, Hashimoto T, Kawashima Y
First Department of Surgery, Osaka University Medical School, Japan.
Surgery. 1990 Jan;107(1):55-62.
The portal and systemic hemodynamics in 23 patients with esophageal varices caused by portal hypertension were studied by the thermodilution method with a thermodilution catheter. The patients had a mean age of 48.2 years and underwent splenectomy and devascularization with (17 cases) or without cardiectomy (six cases). The initial portal venous blood flow in all 23 patients was 0.99 +/- 0.31 L/min/m2, and this decreased significantly after splenectomy to 0.67 +/- 0.29 L/min/m2 in proportion to the resected spleen weight. The initial portal venous pressure was 36.5 +/- 6.8 cm H2O, and this decreased after splenectomy to 29.1 +/- 5.7 cm H2O but returned to the initial level after the devascularization procedure. Thus the portal hypertensive status was preserved in spite of the reduction in portal venous blood flow. There was no difference in the pattern of portal hemodynamic change between the patients who underwent cardiectomy and those who did not. In conclusion, it is indicated that the portal hemodynamic change after the devascularization procedure was not caused by cardiectomy but by the lack of splenic blood flow to the portal vein after splenectomy.
采用热稀释导管通过热稀释法对23例门静脉高压所致食管静脉曲张患者的门静脉和体循环血流动力学进行了研究。患者平均年龄48.2岁，17例行脾切除加去血管化术，6例行脾切除加去血管化术但未行贲门切除术。23例患者的初始门静脉血流量为0.99±0.31L/min/m²，脾切除术后显著下降至0.67±0.29L/min/m²，与切除的脾脏重量成比例。初始门静脉压力为36.5±6.8cmH₂O，脾切除术后降至29.1±5.7cmH₂O，但去血管化术后恢复至初始水平。因此，尽管门静脉血流量减少，但门静脉高压状态得以保留。行贲门切除术的患者与未行贲门切除术的患者门静脉血流动力学变化模式无差异。总之，表明去血管化术后门静脉血流动力学变化不是由贲门切除术引起的，而是由脾切除术后脾静脉向门静脉供血不足所致。
