介入性门脉断流术对门静脉血流动力学的影响

赵春红 季良

摘要：目的  观察介入性门脉断流术对门静脉血流动力学指标的影响。方法  选取2018年1月～2019年1月在我院治疗的60例乙肝肝硬化因食管胃底静脉曲张出血合并脾功亢进患者为研究对象，均采用胃冠状静脉栓塞加部分脾栓塞术治疗，比较治疗前后自由门静脉压（FPP）及门静脉及脾静脉介入术后6周门静脉（PV）和脾静脉（SV）的血流动力学指标（内径、平均血流速度、血流量）。结果  胃冠状静脉栓塞术后FPP（42.61±5.02）cmH2O高于术前（37.01±4.22）cmH2O，差异有统计学意义（P<0.05），联合部分脾栓塞术后FPP（36.03±5.44）cmH2O下降，与胃冠状静脉栓塞术后比较，差异有统计学意义（P<0.05），但与术前比较， 差异无统计学意义（P>0.05）;术后6周PV内径、平均血流速度、血流量与术前比较，差异无统计学意义（P>0.05）;SV内径、平均血流速度、血流量均小于术前，差异有统计学意义（P<0.05）。结论  胃冠状静脉栓塞术会引起门静脉压力升高，但联合部分脾栓塞术后FPP会降低，且不影响门静脉血流动力学变化，对临床合理选择治疗方式具有重要的指导意义。

关键词：介入性;门脉断流术;门静脉;血流动力学指标

中图分类号：R575.2                                 文献标识码：A                                 DOI：10.3969/j.issn.1006-1959.2020.08.033

文章編号：1006-1959（2020）08-0108-02

Abstract：Objective  To observe the influence of interventional portal vein devascularization on portal hemodynamics.Methods  60 patients with hepatitis B cirrhosis due to esophagogastric varices bleeding and hypersplenism treated in our hospital from January 2018 to January 2019 were selected as the research subjects. All patients were treated with gastric coronary vein embolization plus partial splenic embolization. Before and after treatment， free portal vein pressure （FPP） and hemodynamic indicators （internal diameter， average blood flow velocity， blood flow） of portal vein （PV） and splenic vein （SV） 6 weeks after portal vein and splenic vein intervention.Results  The FPP （42.61±5.02） cmH2O after gastric coronary embolization was higher than that before （37.01±4.22） cmH2O， the difference was statistically significant （P<0.05）， and the FPP （36.03±5.44） cmH2O decreased after combined partial splenic embolization. Compared with postoperative gastric coronary embolism， the difference was statistically significant（P<0.05）， but compared with preoperatively， the difference was not statistically significant（P>0.05）; There was no statistically significant difference in PV inner diameter， average blood flow velocity and blood flow compared with preoperative 6 weeks after surgery（P>0.05）; SV inner diameter， average blood flow velocity and blood flow were less than before surgery， the difference was statistically significant（P<0.05）.Conclusion  Gastric coronary vein embolization can cause increased portal vein pressure， but FPP will decrease after combined partial splenic embolization， and it will not affect the hemodynamic changes of the portal vein. It has important guiding significance for the rational choice of clinical treatment.