小直径H型移植门腔分流术对门静脉血流的影响。

The effect of small-diameter H-graft portacaval shunts on portal blood flow.

作者信息

Rosemurgy A S, Goode S E, Camps M

机构信息

Department of Surgery, University of South Florida, Tampa, USA.

出版信息

Am J Surg. 1996 Jan;171(1):154-6; discussion 156-7. doi: 10.1016/S0002-9610(99)80091-9.

DOI:10.1016/S0002-9610(99)80091-9

PMID:8554131

Abstract

BACKGROUND

Small-diameter prosthetic H-graft portacaval shunts have been shown to promote preservation of total hepatic blood flow relative to large-diameter H-graft shunts. Nonetheless, specific changes in portal hemodynamics occurring with small-diameter H-graft shunting are unknown. This study was undertaken to evaluate changes in portal flow that occur with these shunts.

METHODS

Portal vein and inferior vena cava (IVC) blood flow were determined intraoperatively in 36 consecutive adults before and after prosthetic H-graft portacaval shunting using color-flow Doppler ultrasound. Postshunt measurements were made immediately cephalad and caudad to the shunt. Comparisons were undertaken using a paired Student's t-test with 95% confidence.

RESULTS

Portal pressures decreased in all (P < 0.001), but never to normal. Postshunt portal flow cephalad and caudad to the shunt were not different from preshunt flow (P = 0.09, P = 0.28, respectively), although they were different from each other (P = 0.004). Postshunt IVC flow cephalad to the shunt was greater than caudad IVC flow (P = 0.004) and greater than preshunt IVC flow (P < 0.001), reflecting high flow through the shunt into the IVC.

CONCLUSIONS

Small-diameter prosthetic H-graft portacaval shunts divert a significant amount of blood from the portal vein and significantly decrease portal pressures. The decreases in portal pressures with shunting are significant whereas changes in portal blood flow into the liver are not. These findings help explain the low incidence of variceal rebleeding and hepatic dysfunction after these shunts.

摘要

背景

相对于大口径H型移植分流术，小口径人工血管H型门腔分流术已被证明可促进总肝血流量的保留。然而，小口径H型移植分流术所导致的门静脉血流动力学的具体变化尚不清楚。本研究旨在评估这些分流术所引起的门静脉血流变化。

方法

在36例连续的成年患者中，使用彩色多普勒超声在人工血管H型门腔分流术前后术中测定门静脉和下腔静脉（IVC）血流。分流术后立即在分流处头侧和尾侧进行测量。采用配对t检验进行比较，置信度为95%。

结果

所有患者的门静脉压力均下降（P<0.001），但从未恢复正常。尽管分流术后分流处头侧和尾侧的门静脉血流彼此不同（P = 0.004），但与分流术前的血流无差异（分别为P = 0.09和P = 0.28）。分流术后分流处头侧的IVC血流大于尾侧的IVC血流（P = 0.004），且大于分流术前的IVC血流（P<0.001），这反映了通过分流进入IVC的高血流量。