Kokudo N, Kawasaki S, Ohashi K, Sakamoto H, Koyama H, Sanjo K, Idezuki Y
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Gut. 1989 Oct;30(10):1396-400. doi: 10.1136/gut.30.10.1396.
Azygos venous blood flow and other haemodynamic parameters were measured in 14 cirrhotic patients to investigate the effects of a non-shunting operation, oesophageal transection with paraoesophagogastric devascularisation. Azygos venous blood flow measured by the local continuous thermal dilution method was significantly reduced by 13.8% after the operation (428 (41) v 369 (33) ml/min). Hepatic venous pressure gradient (HVPG) was also significantly decreased from 14.5 (0.8) to 12.8 (0.7) mmHg (-11.8%). Cardiac output and routine liver tests did not change remarkably postoperatively. In this haemodynamic study before and after non-shunting operation, moderate but significant decreases were seen in azygos venous blood flow and portal pressure (HVPG), without substantial changes in systemic circulation. This suggests that blood flow through the portosystemic collaterals other than oesophageal varices may be decreased but still adequate after the operation. Well preserved portosystemic collaterals without oesophageal varices are thus considered an optimally balanced state after non-shunting operation.
对14例肝硬化患者测量了奇静脉血流及其他血流动力学参数，以研究一种非分流手术——食管横断术加食管旁胃去血管化术的效果。采用局部连续热稀释法测量的奇静脉血流在术后显著减少了13.8%（从428（41）ml/min降至369（33）ml/min）。肝静脉压力梯度（HVPG）也从14.5（0.8）mmHg显著降至12.8（0.7）mmHg（-11.8%）。心输出量和常规肝功能检查术后无明显变化。在这项非分流手术前后的血流动力学研究中，奇静脉血流和门静脉压力（HVPG）出现了中度但显著的下降，而体循环无实质性变化。这表明，除食管静脉曲张外，通过门体侧支循环的血流可能减少，但术后仍充足。因此，无食管静脉曲张且保存良好的门体侧支循环被认为是非分流手术后的最佳平衡状态。
