Nanashima Atsushi, Abo Takafumi, Arai Junichi, Tominaga Tetsuro, Takagi Katsunori, Mochinaga Koji, Furukawa Katsuro, Nagayasu Takeshi
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
J Surg Res. 2014 Dec;192(2):395-401. doi: 10.1016/j.jss.2014.05.069. Epub 2014 Jun 2.
Portal hypertension is a major risk factor for hepatic failure or bleeding in patients who have undergone hepatectomy, but it cannot be measured indirectly. We attempted to evaluate the intraoperative ultrasonography parameters that correlate with portal pressure (PP) in patients undergoing hepatectomy.
We examined 30 patients in whom PP was directly measured during surgery. The background liver conditions included chronic viral liver disease in seven patients, chemotherapy-associated steatohepatitis in four patients, fatty liver in one patient, hepatolithiasis in one patient, obstructive jaundice in one patient, and a normal liver in 16 patients. A multivariate logistic analysis and linear regression analysis were conducted to develop a predictive formula for PP.
The mean PP was 10.4 ± 4.1 mm Hg. The PP tended to be increased in patients with chronic viral hepatitis. A univariate analysis identified the association of the six following parameters with PP: the platelet count and the maximum (max), minimum (min), endo-diastolic, peak-systolic, and mean velocity in the portal vein (PV) flow. Using multiple linear regression analysis, the predictive formula using the PV max and min was as follows: Y (estimated PP) = 18.235-0.120 × (PV max.[m/s])-0.364 × (PV min). The calculated PP (10.44 ± 2.61 mm Hg) was nearly the same as the actual PP (10.43 ± 4.07 mm Hg). However, there was no significant relationship between the calculated PP and the intraoperative blood loss and post hepatectomy morbidity.
This formula, which uses ultrasonographic Doppler flow parameters, appears to be useful for predicting PP.
门静脉高压是肝切除患者发生肝衰竭或出血的主要危险因素，但无法间接测量。我们试图评估肝切除患者术中与门静脉压力（PP）相关的超声参数。
我们检查了30例术中直接测量PP的患者。其肝脏背景情况包括7例慢性病毒性肝病、4例化疗相关脂肪性肝炎、1例脂肪肝、1例肝内胆管结石、1例梗阻性黄疸以及16例肝脏正常的患者。进行多因素逻辑回归分析和线性回归分析以建立PP的预测公式。
平均PP为10.4±4.1mmHg。慢性病毒性肝炎患者的PP往往升高。单因素分析确定了以下六个参数与PP相关：血小板计数以及门静脉（PV）血流的最大、最小、舒张末期、收缩期峰值和平均流速。使用多元线性回归分析，使用PV最大和最小值的预测公式如下：Y（估计的PP）=18.235 - 0.120×（PV最大.[m/s]） - 0.364×（PV最小）。计算出的PP（10.44±2.61mmHg）与实际PP（10.43±4.07mmHg）几乎相同。然而，计算出的PP与术中失血量和肝切除术后发病率之间无显著关系。
这个使用超声多普勒血流参数的公式似乎有助于预测PP。
