脾肾静脉分流联合断流术与单纯断流术远期疗效比较 作者:刘巍罗蒙孙勇伟花荣刘骅吴志勇 【摘要】目的评价近端脾肾静脉分流加门奇断流联合手术和单纯门奇断流术的远期临床疗效。方法回顾性总结近10年采用脾肾静脉分流加门奇断流联合手术和单纯门奇断流术治疗门静脉高压症384例,从术后再出血、脑病、肝功能衰竭发生率三方面总结临床疗效;于术前1周和术后2周应用核磁共振血管造影测量门静脉、脾静脉和肠系膜上静脉的直径、流速和流量,并于术中动态测量门静脉压力。结果联合手术组术后再出血率明显低于断流组,而肝功能和脑病发生率两组差异无统计学意义。联合手术组手术前后门静脉血流量下降差异有统计学意义。联合手术组和断流组门静脉血流量减少差异无统计学意义,但是自由门静脉压的下降差异有统计学意义。结论联合手术可结合断流和分流手术的优点,明显降低出血率,而且不增加脑病和肝衰竭发生率,应成为治疗门静脉高压症合并出血的首选术式。 【关键词】高血压,门静脉;脾肾静脉分流术;断流术;血流动力学 Abstract Objective To evaluate the clinical effects of pericardial devascularization (PCDV) and proximal spleno-renal shunt (PSRS) combined with PCDV. Methods A retrospective analysis was carried out in 384 cases with portal hypertension treated with PCDV (PCFV group) or PSRS plus PCDV (combination group). The incidence of rebleeding, post-operative hepatic encephalopathy and hepatic function failure were summarized. The diameter, blood flow velocity and blood flow of portal vein, splenic vein and superior mesenteric vein were measured with ic resonance angiograph at 1 week preoperatively and at 2 weeks postoperatively. Free portal pressure (FPP) was dynamically determined during operation. Results The post-operative rebleeding rate bination group was obviously low er than that in the pericardial devascularization group, but there was no statistical difference in the liver function and the incidence of hepatic encephalopathy in both groups(P<). The difference of the decreasing of the blood flow volume of the portal vein before and after the operation had statistical significance in bination group. There was no significant difference on decreasing of blood flow of the portal vein, but very significant difference on decreasing of FPP bination group and PCDV group(P<). Conclusion PSRS plus PCDV should be the first choice for the treatment of the portal bined with hemorrhage because it integrates advantages of shunt and devascularization, significantly decreases incidence of re bleeing and avoids increasing of hepatic encephalopat
