Brandt C T, Caneca O A, Tavares D J, Avila Júnior L
Hospital das Clinicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Trans R Soc Trop Med Hyg. 1995 Jan-Feb;89(1):70-1. doi: 10.1016/0035-9203(95)90665-7.
From January 1990 to September 1993, 25 children with hepatosplenic schistosomiasis mansoni and oesophageal varices underwent splenectomy, ligature of the left gastric vein and autoimplantation of 100 g of spleen into the great omentum at the University Hospital, Recife, Brazil. The diameters and the blood flow velocities of the portal vein and the hepatic artery were measured before and after surgery. A Doppler Duplex (Aloka 680) with a convex transductor of 3.5 MHz was used. Post-operative follow-up revealed (i) a significant decrease in the mean diameter of the portal vein from 12.6 +/- 2.1 mm to 9.6 +/- 1.9 mm, (ii) a significant increase in the mean diameter of the hepatic artery from 5.0 +/- 1.4 mm to 5.3 +/- 1.2 mm, (iii) a significant decrease in the mean blood flow velocity in the portal vein from 31.1 +/- 8.0 cm/s to 22.4 +/- 7.1 cm/s, and (iv) no significant change in blood flow velocity in the hepatic artery. The study supports the concept that surgical treatment for portal hypertension in patients with hepatosplenic schistosomiasis mansoni, which includes splenectomy, results in a decrease of venous portal blood flow to the liver associated with an increase in the arterial hepatic blood flow. The physiological implications of these haemodynamic changes in the long term remain to be investigated.
1990年1月至1993年9月，巴西累西腓大学医院对25例患有曼氏血吸虫病致肝脾肿大及食管静脉曲张的儿童进行了脾切除术、胃左静脉结扎术，并将100克脾脏自体植入大网膜。手术前后测量门静脉和肝动脉的直径及血流速度。使用配有3.5MHz凸阵探头的多普勒双功能超声仪（Aloka 680）。术后随访显示：（i）门静脉平均直径从12.6±2.1毫米显著降至9.6±1.9毫米；（ii）肝动脉平均直径从5.0±1.4毫米显著增至5.3±1.2毫米；（iii）门静脉平均血流速度从31.1±8.0厘米/秒显著降至22.4±7.1厘米/秒；（iv）肝动脉血流速度无显著变化。该研究支持这样一种观点，即对患有曼氏血吸虫病致肝脾肿大的患者进行包括脾切除术在内的门静脉高压手术治疗，会导致进入肝脏的门静脉血流减少，同时肝动脉血流增加。这些血流动力学变化的长期生理影响仍有待研究。
