CAJ | 학술논문

目的建立猪远端胃大部分切除术后合并门静脉高压症模型,观察该模型门脉系统的血流动力学变化.方法将26只家猪随机分为3组,实验组(EG,10只)一期行远端胃大部分切除、二期行门静脉部分缩窄术；门静脉高压组(PG,10只)一期行开关腹、二期行门静脉部分缩窄术；假手术组(SG,6只)一、二期均行开关腹.3组均测定门静脉压力,二期手术后两月行CTA及腹腔干、门静脉系统血管铸型.结果与假手术组比较,实验组、门静脉高压组术后均形成了门静脉高压.实验组与门静脉高压组术后及术后两个月门静脉压力差异无统计学意义(P＞0.05).远端胃大部分切除术后合并门静脉高压症,胃的血供主要由胃左动静脉及胃网膜左动静脉提供,没有形成新的侧支循环.结论远端胃大部分切除术后合并门静脉高压症,不宜行贲门周围血管离断术,治疗上需对患者的门腔系统行血管成像检查,根据情况选择适当的治疗方式.
목적 건립저원단위대부분절제술후합병문정맥고압증모형,관찰해모형문맥계통적혈류동역학변화.방법 장26지가저수궤분위3조,실험조(EG,10지)일기행원단위대부분절제、이기행문정맥부분축착술；문정맥고압조(PG,10지)일기행개관복、이기행문정맥부분축착술；가수술조(SG,6지)일、이기균행개관복.3조균측정문정맥압력,이기수술후량월행CTA급복강간、문정맥계통혈관주형.결과 여가수술조비교,실험조、문정맥고압조술후균형성료문정맥고압.실험조여문정맥고압조술후급술후량개월문정맥압력차이무통계학의의(P＞0.05).원단위대부분절제술후합병문정맥고압증,위적혈공주요유위좌동정맥급위망막좌동정맥제공,몰유형성신적측지순배.결론 원단위대부분절제술후합병문정맥고압증,불의행분문주위혈관리단술,치료상수대환자적문강계통행혈관성상검사,근거정황선택괄당적치료방식.
Objective To build up a pig model of portal hypertension combined with subtotal gastrectomy,and study the hemodynamic changes of portal vein system.Methods 26 Susscrota domesticas are divided into three groups randomly.The experimental group ( EG,n =10) will receive the subtotal gastrectomy in the onestage operation,and will be subtotally coarctated the vena portae after one month.The portal hypertension group (PG,n =10) will receive the sham subtotal gastrectomy at first and followed by subtotally coarctated the vena portae.And the shamoperated group ( SG,n =6) will receive the sham subtotal gastrectomy at first and the sham subtotally coarctated the vena portae one month later.The portal pressure will be measured,and the hemodynamic changes in all groups will be detected by computer tomography and cast form.Results ( 1 ) The portal pressure in the EG and PG are statistically significance higher than the SG.And no difference was found between the EG and PG after the operation.(2) After subtotal gastrectomy,there are no new blood vessel appear in the gastric stump and the anastomosis between the stomach and the intestines.The blood supply of the gastric stump are mainly supported by the left gastric arteria and arteriae gastro-omentalis sinistra.The venous return of the gastric are mainly through the left gastric vein and left gastroepiploic vein.Conclusion ( 1 ) The method of subtotally coarctating the vena portae can build up a model of portal hypertension combined with subtotal gastrectomy.(2) The patients of portal hypertension who alreadly underwent subtotal gastrectomy is not suitable for the pericardial devascularization and the modified Sugiura procedure.