CAJ | 학술논문

目的探讨肝硬化胆囊壁的不同分型与门静脉主干及右支血流动力学变化的关系.方法采用高频超声联合二维及彩色超声观察肝硬化组(69例)和对照组(30名)的胆囊壁分型、厚度、门静脉主干内径(D_(pv))、门静脉主干血流速度(V_(pv))、门静脉主干血流量(Q_(pv))、门静脉右支内径(D_(rpv))、门静脉右支血流速度(V_(rpv))、门静脉右支血流量(Q_(rpv)).同时根据胆囊壁的不同分型将69例肝硬化患者分为胆囊壁不厚亚组、单纯增厚亚组和双边亚组,对比肝硬化各组与对照组以上检测指标的差异.结果各组间胆囊壁厚度均存在差异(P<0.05);D_(pv)除胆囊壁不厚亚组与单纯增厚亚组间差异无统计学意义外,其余各组间差异均有统计学意义(P<0.01);V_(pv)仅单纯增厚亚组与对照组、双边亚组与对照组间差异有统计学意义(P<0.01);Q_(pv)在双边亚组与其余各组间差异有统计学意义(P<0.05).D_(rpv)、Q_(rpv)各组间差异均无统计学意义;V_(rpv)对照组分别与单纯增厚亚组及双边亚组间差异有统计学意义(P<0.05).肝硬化组与对照组Q_(rpv)/Q_(pv)比值差异无统计学意义(P>0.05).胆囊壁厚度与D_(pv)呈正相关(r=0.886,P<0.01).结论肝硬化时高频超声下胆囊壁的不同分型与门静脉主干血流动力学变化关系密切,而与门静脉右支血流动力学变化无相关性;胆囊静脉回流受阻并非肝硬化门静脉高压胆囊壁变化主要的血流动力学原因,其发生可能有更内在的机制.
목적 탐토간경화담낭벽적불동분형여문정맥주간급우지혈류동역학변화적관계.방법 채용고빈초성연합이유급채색초성관찰간경화조(69례)화대조조(30명)적담낭벽분형、후도、문정맥주간내경(D_(pv))、문정맥주간혈류속도(V_(pv))、문정맥주간혈류량(Q_(pv))、문정맥우지내경(D_(rpv))、문정맥우지혈류속도(V_(rpv))、문정맥우지혈류량(Q_(rpv)).동시근거담낭벽적불동분형장69례간경화환자분위담낭벽불후아조、단순증후아조화쌍변아조,대비간경화각조여대조조이상검측지표적차이.결과 각조간담낭벽후도균존재차이(P<0.05);D_(pv)제담낭벽불후아조여단순증후아조간차이무통계학의의외,기여각조간차이균유통계학의의(P<0.01);V_(pv)부단순증후아조여대조조、쌍변아조여대조조간차이유통계학의의(P<0.01);Q_(pv)재쌍변아조여기여각조간차이유통계학의의(P<0.05).D_(rpv)、Q_(rpv)각조간차이균무통계학의의;V_(rpv)대조조분별여단순증후아조급쌍변아조간차이유통계학의의(P<0.05).간경화조여대조조Q_(rpv)/Q_(pv)비치차이무통계학의의(P>0.05).담낭벽후도여D_(pv)정정상관(r=0.886,P<0.01).결론 간경화시고빈초성하담낭벽적불동분형여문정맥주간혈류동역학변화관계밀절,이여문정맥우지혈류동역학변화무상관성;담낭정맥회류수조병비간경화문정맥고압담낭벽변화주요적혈류동역학원인,기발생가능유경내재적궤제.
Objective To investigate the relationship between gallbladder wall-typing and the main portal vein, right portal vein hemodynamics in patients with liver cirrhosis. Methods The main portal vein, right portal vein hemodynamics and the thickness of gallbladder wall were examined in 69 patients with cirrhosis and 30 normal subjects (control group) with two-dimensional ultrasound, color Doppler ultrasound and high-frequency ultrasound. According to the gallbladder wall-typing, 69 patients with liver cirrhosis were divided into "not thickened", "simple thickening" and "bilateral" subgroups. The paremeters of hemodynamics and the thickness of gallbladder wall were compared among groups. Results There was statistical difference in thickness of gallbladder wall among all 3 subgroups. Statistical difference of the diameter of main portal vein (D_(pv)) was found among the subgroups (P<0.01), except between "not thickened" and "simple thickening" subgroup. Statistical difference of the velocity of the main portal vein (V_(pv)) was found between "simple thickening subgroup" and control group, as well as between "bilateral subgroup" and the control group (P<0.01). Statistical differences of quantity of blood flow in the main portal vein (Q_(pv)) were detected between "bilateral subgroup" and other 2 subgroups and control group (P<0.05). No statistical difference of diameter of right portal vein (D_(rpv)) and quantity of blood flow in the right portal vein (Q_(rpv)) was found among all groups and subgroups. The velocity of the right portal vein (V_(rpv)) of "bilateral subgroup" was statistically different with that of the control group and the "simple thickening subgroup" (P<0.05). No statistical difference of Q_(rpv)/Q_(pv) existed between the patients with liver cirrhosis and the normal subjects (P>0.05). There was positive correlation between the gallbladder wall thickness and D_(pv) (r=0.886, P<0.01). Conclusion The gallbladder wall-typing has no correlation with the right portal vein hemodynamics, but is related with the main portal vein hemodynamics. The bilateral and the thickness of gallbladder wall can indirectly reflect the hemodynamic changes of main portal vein. Obstruction to flow of cystic vein is not the main hemodynamic cause for the gallbladder wall changes in patients with liver cirrhosis and portal hypertension cause, indicating that there may be some intrinsic mechanisms of this phenomenon.