【摘要】 目的观察门静脉动脉化+完全门体分流(PACS)术和传统的脾肾分流(SRS)术及贲门周围血管离断(PCDV)术对门静脉血流动力学的影响。方法制备门静脉高压动物模型,PCDV组行脾切除、贲门周围血管离断术;SRS组采用脾切除、远端脾肾分流术;PACS组采用脾切除、门静脉-脾动脉吻合、门静脉-腔静脉吻合。应用彩色多普勒超声及有创性测压管于开腹后即刻、手术完成即刻及治疗后2周测量门静脉血流量(PVF)及门静脉压力(PVP),PACS组包括入肝及入下腔静脉PVF、PVP。手术前、后测定肝功能指标。结果PCDV组术后2周PVF下降约17%,PVP下降约5%;SRS组术后2周PVF下降约51%,PVP下降约51%;PACS组术后2周入肝PVF上升至开腹后即刻的180%,入肝PVP上升至开腹后即刻的196%,入下腔静脉PVF增至开腹后即刻的130%,入下腔静脉PVP保持低压,约为开腹后即刻的46%。术后2周PACS组入肝PVP、PVF及入下腔静脉PVF均明显高于另2组(P<0.05,P<0.01),而入下腔静脉PVP则明显低于PCDV组(P<0.05)。3组中仅SRS组术后2周ALT较术前明显升高(P<0.05)。结论PACS术成功率较高,手术死亡率与SRS术相近,可同时提高入肝血流和降低侧支压力,而且短期内未明显影响肝脏功能,是一种值得尝试和进一步研究的新手术方法。更多还原

【Abstract】 Objective To study the effect on liver hemodynamics of portal arterialization and complete shunt(PACS),splenorenal shut(SRS) and peripheral cardia divided vessel(PCDV).Methods The preparation of canine model was made.Group PCDV accepted a splenectomy and peripheral cardia divided vessel,while the group SRS accepted a spleen-renal vein shunt.Group PACS accepted a splenectomy,splenic artery and upper portal vein anastomosis,and complete portal-caval shunt.The blood pressure and flow of the portal system were observed.The hepatic function was also measured before and 2 weeks after the three kinds of operation.Results In the PCDV group,the postoperative PVF decreased in 17% while PVP decreased in 5%.In the SRS group,the postoperative PVF decreased in 51% while PVP decreased in 51%.In the PACS group,the postoperative hepatic inflow PVF increased to 180% of the former while PVP increased to 196%;the caval-inflow PVF increased to 130% of the former while PVP decreased to 46%.The results of PACS group had a magnificent statistic difference comparing with those two traditional operations(P<0.05,P<0.01).ALT obviously increased after SRS(P<0.05),whereas slightly changed after the other two.Conclusion PACS can significantly increase the hepatic inflow and decreased the blood pressure of the portal system with a pleasant dog survival,and without obvious influence to the hepatic function.It may be a worthy attempt in the treatment of portal hypertension and need more research work going on.更多还原