Gusberg R J, Peterec S M, Sumpio B E, Meier G H
Department of Surgery, Yale University School of Medicine.
Hepatogastroenterology. 1994 Dec;41(6):573-7.
Splenectomy and splenic embolization have been advocated as definitive therapy in cirrhotic patients bleeding from varices. While splenomegaly is commonly associated with portal hypertension, no clear hemodynamic link between portal pressure and splenic enlargement has yet been established. In an effort to clarify the hemodynamic significance of splenomegaly in portal hypertensive patients the relationship between spleen size and portal pressure was retrospectively reviewed and the contribution of splenic inflow to portal hypertension prospectively studied. In 50 consecutive cirrhotic variceal bleeders studied angiographically, there was no correlation between spleen size and corrected sinusoidal pressure. Portal pressure was then prospectively measured before and after splenic vein clamping in 12 cirrhotic patients undergoing distal splenorenal shunt. No significant pressure drop occurred following elimination of splenic venous flow. On the basis of these data, there would appear to be no firm hemodynamic basis for splenectomy or splenic embolization alone in the unselective management of cirrhotic patients with variceal bleeding.
脾切除术和脾动脉栓塞术已被提倡作为肝硬化静脉曲张出血患者的确定性治疗方法。虽然脾肿大通常与门静脉高压相关，但门静脉压力与脾肿大之间尚未建立明确的血流动力学联系。为了阐明脾肿大在门静脉高压患者中的血流动力学意义，回顾性分析了脾脏大小与门静脉压力之间的关系，并前瞻性研究了脾血流对门静脉高压的影响。在连续50例接受血管造影研究的肝硬化静脉曲张出血患者中，脾脏大小与校正后的窦状隙压力之间无相关性。然后，对12例接受远端脾肾分流术的肝硬化患者在脾静脉夹闭前后进行了门静脉压力的前瞻性测量。消除脾静脉血流后未出现明显的压力下降。基于这些数据，在无选择地治疗肝硬化静脉曲张出血患者时，单独进行脾切除术或脾动脉栓塞术似乎没有坚实的血流动力学依据。
