Rosemurgy A S, McAllister E W, Godellas C V, Goode S E, Albrink M H, Fabri P J
Department of Surgery, University of South Florida, Tampa 33606, USA.
J Surg Res. 1995 Dec;59(6):627-30. doi: 10.1006/jsre.1995.1215.
With the advent of transjugular intrahepatic porta-systemic stent shunt and the wider application of the surgically placed small diameter prosthetic H-graft portacaval shunt (HGPCS), partial portal decompression in the treatment of portal hypertension has received increased attention. The clinical results supporting the use of partial portal decompression are its low incidence of variceal rehemorrhage due to decreased portal pressures and its low rate of hepatic failure, possibly due to maintenance of blood flow to the liver. Surprisingly, nothing is known about changes in portal hemodynamics and effective hepatic blood flow following partial portal decompression. To prospectively evaluate changes in portal hemodynamics and effective hepatic blood flow brought about by partial portal decompression, the following were determined in seven patients undergoing HGPCS: intraoperative pre- and postshunt portal vein pressures and portal vein-inferior vena cava pressure gradients, intraoperative pre- and postshunt portal vein flow, and pre- and postoperative effective hepatic blood flow. With HGPCS, portal vein pressures and portal vein-inferior vena cava pressure gradients decreased significantly, although portal pressures remained above normal. In contrast to the significant decreases in portal pressures, portal vein blood flow and effective hepatic blood flow do not decrease significantly. Changes in portal vein pressures and portal vein-inferior vena cava pressure gradients are great when compared to changes in portal vein flow and effective hepatic blood flow. Reduction of portal hypertension with concomitant maintenance of hepatic blood flow may explain why hepatic dysfunction is avoided following partial portal decompression.
随着经颈静脉肝内门体分流术的出现以及手术放置的小直径人工H型移植门腔分流术（HGPCS）的更广泛应用，部分门体减压在门静脉高压治疗中的应用受到了更多关注。支持使用部分门体减压的临床结果是，由于门静脉压力降低，静脉曲张再出血的发生率较低，以及肝衰竭发生率较低，这可能是由于维持了肝脏的血流。令人惊讶的是，关于部分门体减压后门静脉血流动力学和有效肝血流量的变化却一无所知。为了前瞻性评估部分门体减压引起的门静脉血流动力学和有效肝血流量的变化，对7例行HGPCS的患者进行了以下测定：术中分流前后的门静脉压力和门静脉-下腔静脉压力梯度、术中分流前后的门静脉血流量以及术前和术后的有效肝血流量。采用HGPCS时，门静脉压力和门静脉-下腔静脉压力梯度显著降低，尽管门静脉压力仍高于正常水平。与门静脉压力的显著降低相反，门静脉血流量和有效肝血流量并未显著减少。与门静脉血流量和有效肝血流量的变化相比，门静脉压力和门静脉-下腔静脉压力梯度的变化较大。门静脉高压的降低同时维持肝血流量，这可能解释了为什么部分门体减压后可避免肝功能障碍。
