CAJ | 학술논문

目的分析肝炎肝硬化门静脉高压症Hassab术后患者不同时期食管胃静脉曲张情况与门静脉血流动力学变化,评估患者预后.方法对161例患者Hassab术前、术后6、12、18、24个月,内镜检查食管、胃底静脉曲张情况,彩色多普勒检测门静脉血流动力学变化,评价Child-Pugh肝功能分级情况.结果术后6、12、18个月内轻度食管静脉曲张患者比例分别为44.0%、34.8%、28.3%,较术前(7.5%)增高(P＜0.05),重度食管静脉曲张比例术后6、12、18个月内分别为25.2%、29.7%、34.9%,较术前(65.2%)降低(P＜0.05);胃底静脉曲张发生率与食管静脉曲张程度相关.术后12个月内门静脉主干、门静脉右支内径较术前缩小(P＜0.05),门静脉主干最大血流速度及血流量、门静脉左支平均血流速度减慢(P＜0.05),门静脉右支平均血流速度在术后6个月时较术前减慢(P＜0.05).术后6、12、18个月内Child-Pugh分级肝功A级患者比例分别为63.5%、60.6%、57.9%,较术前(4 8.4%)升高(P＜0.05).但至术后24个月时,各项指标均接近于术前水平.结论 Hassab术后患者18个月内整体食管静脉曲张程度减轻,术后12个月内门静脉血流动力学降低,术后18个月内整体肝功能改善.
목적 분석간염간경화문정맥고압증Hassab술후환자불동시기식관위정맥곡장정황여문정맥혈류동역학변화,평고환자예후.방법 대161례환자Hassab술전、술후6、12、18、24개월,내경검사식관、위저정맥곡장정황,채색다보륵검측문정맥혈류동역학변화,평개Child-Pugh간공능분급정황.결과 술후6、12、18개월내경도식관정맥곡장환자비례분별위44.0%、34.8%、28.3%,교술전(7.5%)증고(P＜0.05),중도식관정맥곡장비례술후6、12、18개월내분별위25.2%、29.7%、34.9%,교술전(65.2%)강저(P＜0.05);위저정맥곡장발생솔여식관정맥곡장정도상관.술후12개월내문정맥주간、문정맥우지내경교술전축소(P＜0.05),문정맥주간최대혈류속도급혈류량、문정맥좌지평균혈류속도감만(P＜0.05),문정맥우지평균혈류속도재술후6개월시교술전감만(P＜0.05).술후6、12、18개월내Child-Pugh분급간공A급환자비례분별위63.5%、60.6%、57.9%,교술전(4 8.4%)승고(P＜0.05).단지술후24개월시,각항지표균접근우술전수평.결론 Hassab술후환자18개월내정체식관정맥곡장정도감경,술후12개월내문정맥혈류동역학강저,술후18개월내정체간공능개선.
Objective To analyze the changes of varicosis and hemodynamics in cirrhotic patients with portal vein hypertension at different stages after Hassab devascularization, and to evaluate the outcome.Methods Hassab devascularization was performed in 161 patients with portal vein hypertension, who were all evaluated by means of endoscopy, Doppler color imaging and Child-Pugh grading before and 6, 12, 18,24 months after the procedure, respectively.Results The rates of mild esophageal varicosis were 44.0%,34.8% and 28.3% at 6, 12 and 18 months after Hassab devascularization, respectively, which were all significantly higher than that before the operation(7.5%, P ＜ 0.05), while the rates of severe esophageal varicosis were 25.2%, 29.7% and 34.9% at 6, 12 and 18 months after the procedure, which were significantly lower than that before(65.2%, P ＜ 0.05).The incidence of varices in gastric fundus was correlated with the severity of esophageal varices.At 12 months after the operation, the inner diameters of portal vein and its right branch significantly decreased when compared with those before(P ＜ 0.05), the maximal flow rate,volume of portal vein and average flow rate of the left branch also significantly decreased(P ＜ 0.05).At 6 months after the operation, the average flow rate of the right branch slowed down(P ＜ 0.05).Child-Pugh Grade A accounted for 63.5%, 60.6% and 57.9% at 6, 12 and 18 months after the operation, respectively, which were significantly higher than that before(48.4%, P ＜0.05).When evaluated at 24 months after the procedure, all variables were getting close to those before.Conclusion The severity of esophageal varices mitigates in 18 months after Hassab.Hemodynamics of portal vein system decreases in 12 months.The overall liver function improves in 18 months after the operation.