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食管横断术联合脾切除术对门静脉血流动力学的影响。

Effects of esophageal transection combined with splenectomy on portal hemodynamics.

作者信息

Saito M, Ohnishi K, Tanaka H, Sato S, Okuda K, Hirashima T, Hara T

出版信息

Am J Gastroenterol. 1987 Jan;82(1):16-9.

PMID:3799575
Abstract

Portal hemodynamics were studied in 69 patients with cirrhosis and 29 patients with idiopathic portal hypertension to investigate the effects of an operative procedure for varices that consists of transabdominal esophageal mucosal transection, paraesophagogastric devascularization, pyloroplasty, and splenectomy. Portal venous flow measured by the pulsed Doppler flowmeter in 14 patients with cirrhosis and nine patients with idiopathic portal hypertension, who underwent operation 2-5 yr earlier, was significantly reduced compared with that in unoperated 49 patients with cirrhosis and 17 patients with idiopathic portal hypertension who had esophageal varices (410 +/- 158 versus 660 +/- 263 ml/min in cirrhosis; 443 +/- 185 versus 912 +/- 189 ml/min in idiopathic portal hypertension). In nine patients (six cirrhosis, three idiopathic portal hypertension), portal venous flow and portal vein pressure were measured before and after operation. In patients with cirrhosis, portal vein pressure did not change significantly postoperatively even though portal venous flow was reduced. In contrast, portal vein pressure decreased in two patients with idiopathic portal hypertension in whom portal venous flow was reduced. Portal vein pressure was elevated in one patient with idiopathic portal hypertension in whom portal venous flow was increased postoperatively as a result of resection of a large gastro- and splenorenal shunt conducted additionally.

摘要

对69例肝硬化患者和29例特发性门静脉高压患者的门静脉血流动力学进行了研究,以探讨一种由经腹食管黏膜横断术、食管胃周围去血管化、幽门成形术和脾切除术组成的静脉曲张手术操作的效果。对14例肝硬化患者和9例特发性门静脉高压患者进行了门静脉血流测量,这些患者在2 - 5年前接受了手术,与49例未手术的肝硬化患者和17例有食管静脉曲张的特发性门静脉高压患者相比,其门静脉血流显著减少(肝硬化患者中分别为410±158与660±263 ml/min;特发性门静脉高压患者中分别为443±185与912±189 ml/min)。对9例患者(6例肝硬化患者,3例特发性门静脉高压患者)在手术前后测量了门静脉血流和门静脉压力。在肝硬化患者中,尽管门静脉血流减少,但门静脉压力术后无显著变化。相比之下,2例特发性门静脉高压患者门静脉血流减少,门静脉压力下降。1例特发性门静脉高压患者因额外进行了大的胃 - 脾肾分流术切除,术后门静脉血流增加,门静脉压力升高。

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