中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2010年
9期
706-709
,共4页
张英剑%李建生%王伟%刘得纯%金建军%郑玉峰
張英劍%李建生%王偉%劉得純%金建軍%鄭玉峰
장영검%리건생%왕위%류득순%금건군%정옥봉
高血压,门静脉%食管和胃静脉曲张%断流术%血流动力学
高血壓,門靜脈%食管和胃靜脈麯張%斷流術%血流動力學
고혈압,문정맥%식관화위정맥곡장%단류술%혈류동역학
Hypertension,portal%Esophageal and gastric varices%Devascularization%Hemodynamics
目的 观察肝炎后肝硬化门静脉高压症断流术前后食管胃底静脉曲张及门静脉血流动力学的改变.方法 在胃镜下观察肝炎后肝硬化门静脉高压症Hassab手术前后161例患者食管胃底静脉曲张情况,用彩色多普勒检测手术前后不同时期门静脉血流动力学的改变.结果 术后6、12、18个月内轻度食管静脉曲张比例分别为44.1%、34.7%、28.4%,较术前(7.5%)升高(P＜0.05);重度食管静脉曲张比例6、12、18个月分别为25.1%、30.0%、35.0%,较术前(65.2%)降低(P＜0.05);轻度食管静脉曲张伴胃底静脉曲张术前为16.6%、术后6、12、18、24个月分别为7.4%、9.2%、9.1%、10.3%,重度食管静脉曲张伴胃底静脉曲张术前为43.8%、术后6、12、18、24个月分别为45.8%、45.2%、47.4%、48.8%,两者相比差异均有统计学意义(P＜0.05).术后6、12个月内门静脉主干、门静脉右支内径分别为(10.5±2.2)mm、(11.2±1.2)mm、(8.1±1.3)mm、(8.2±2.2)mm,与术前(13.5±1.7)mm、(9.8±2.0)mm相比变小(P＜0.05);术后6、12个月门静脉主干最大血流速度和门静脉左支平均血流速度分别为(11.5±1.6)cm/s、(11.8±1.8)cm/s、(11.0±1.9)cm/s、(11.1±1.9)cm/s,分别较术前(13.6±2.6)cm/s、(13.3±2.6)cm/s减慢(P＜0.05);门静脉主干血流量术后6、12个月分别为(847±249)ml/min和(907±310)ml/min,分别较术前(1095±290)ml/min减少(P＜0.05);门静脉右支平均血流速度在术后6个月时为(11.6±2.6)cm/s,较术前(13.2±2.9)cm/s减慢(P＜0.05).结论 Hassab断流术后18个月内食管静脉曲张程度减轻,18个月后食管静脉曲张程度逐渐增加,而且随食管静脉曲张程度增加胃底静脉曲张发生率增高.Hassab术后12个月内门静脉血流速度减慢、血流量减少、门静脉内径缩小.
目的 觀察肝炎後肝硬化門靜脈高壓癥斷流術前後食管胃底靜脈麯張及門靜脈血流動力學的改變.方法 在胃鏡下觀察肝炎後肝硬化門靜脈高壓癥Hassab手術前後161例患者食管胃底靜脈麯張情況,用綵色多普勒檢測手術前後不同時期門靜脈血流動力學的改變.結果 術後6、12、18箇月內輕度食管靜脈麯張比例分彆為44.1%、34.7%、28.4%,較術前(7.5%)升高(P＜0.05);重度食管靜脈麯張比例6、12、18箇月分彆為25.1%、30.0%、35.0%,較術前(65.2%)降低(P＜0.05);輕度食管靜脈麯張伴胃底靜脈麯張術前為16.6%、術後6、12、18、24箇月分彆為7.4%、9.2%、9.1%、10.3%,重度食管靜脈麯張伴胃底靜脈麯張術前為43.8%、術後6、12、18、24箇月分彆為45.8%、45.2%、47.4%、48.8%,兩者相比差異均有統計學意義(P＜0.05).術後6、12箇月內門靜脈主榦、門靜脈右支內徑分彆為(10.5±2.2)mm、(11.2±1.2)mm、(8.1±1.3)mm、(8.2±2.2)mm,與術前(13.5±1.7)mm、(9.8±2.0)mm相比變小(P＜0.05);術後6、12箇月門靜脈主榦最大血流速度和門靜脈左支平均血流速度分彆為(11.5±1.6)cm/s、(11.8±1.8)cm/s、(11.0±1.9)cm/s、(11.1±1.9)cm/s,分彆較術前(13.6±2.6)cm/s、(13.3±2.6)cm/s減慢(P＜0.05);門靜脈主榦血流量術後6、12箇月分彆為(847±249)ml/min和(907±310)ml/min,分彆較術前(1095±290)ml/min減少(P＜0.05);門靜脈右支平均血流速度在術後6箇月時為(11.6±2.6)cm/s,較術前(13.2±2.9)cm/s減慢(P＜0.05).結論 Hassab斷流術後18箇月內食管靜脈麯張程度減輕,18箇月後食管靜脈麯張程度逐漸增加,而且隨食管靜脈麯張程度增加胃底靜脈麯張髮生率增高.Hassab術後12箇月內門靜脈血流速度減慢、血流量減少、門靜脈內徑縮小.
목적 관찰간염후간경화문정맥고압증단류술전후식관위저정맥곡장급문정맥혈류동역학적개변.방법 재위경하관찰간염후간경화문정맥고압증Hassab수술전후161례환자식관위저정맥곡장정황,용채색다보륵검측수술전후불동시기문정맥혈류동역학적개변.결과 술후6、12、18개월내경도식관정맥곡장비례분별위44.1%、34.7%、28.4%,교술전(7.5%)승고(P＜0.05);중도식관정맥곡장비례6、12、18개월분별위25.1%、30.0%、35.0%,교술전(65.2%)강저(P＜0.05);경도식관정맥곡장반위저정맥곡장술전위16.6%、술후6、12、18、24개월분별위7.4%、9.2%、9.1%、10.3%,중도식관정맥곡장반위저정맥곡장술전위43.8%、술후6、12、18、24개월분별위45.8%、45.2%、47.4%、48.8%,량자상비차이균유통계학의의(P＜0.05).술후6、12개월내문정맥주간、문정맥우지내경분별위(10.5±2.2)mm、(11.2±1.2)mm、(8.1±1.3)mm、(8.2±2.2)mm,여술전(13.5±1.7)mm、(9.8±2.0)mm상비변소(P＜0.05);술후6、12개월문정맥주간최대혈류속도화문정맥좌지평균혈류속도분별위(11.5±1.6)cm/s、(11.8±1.8)cm/s、(11.0±1.9)cm/s、(11.1±1.9)cm/s,분별교술전(13.6±2.6)cm/s、(13.3±2.6)cm/s감만(P＜0.05);문정맥주간혈류량술후6、12개월분별위(847±249)ml/min화(907±310)ml/min,분별교술전(1095±290)ml/min감소(P＜0.05);문정맥우지평균혈류속도재술후6개월시위(11.6±2.6)cm/s,교술전(13.2±2.9)cm/s감만(P＜0.05).결론 Hassab단류술후18개월내식관정맥곡장정도감경,18개월후식관정맥곡장정도축점증가,이차수식관정맥곡장정도증가위저정맥곡장발생솔증고.Hassab술후12개월내문정맥혈류속도감만、혈류량감소、문정맥내경축소.
Objective To investigate changes of esophagogastric varicosis,and portal hemodynamics in cirrhotic portal hypertensive patients after Hassab surgical operation. Method The changes of esophageal varicosis and gastric varices incidences at different phases of cirrhotic patients after the Hassab surgical operation were examined by electric endoscope.Hemodynamics of portal vein system was measured by Doppler color imaging and color Doppler ultrasound after operation. Results Mild esophageal varicosis incidences on the 6th,12th and 18th month after the Hassab surgical operation were respectively 44.1%,34.7% and 28.4%,higher than that before operation (7.5%) (P＜0.05).Severe esophageal varicosis incidences on the 6th,12th and 18th month were respectively 25.1%,30.0% and 35.0%,lower than that before operation (65.2%) (P ＜ 0.05).Mild esophageal varicosis with gastric varices incidences on the 6th,12th,18th and 24th month before and after operation were respectively 16.6%,and 7.4%,9.2%,9.1%,10.3% respectively.Severe esophageal varicosis with gastric varices incidences in the 6th,12th,18th and 24th month were respectively 43.8%,and 45.8%,45.2%,47.4%,48.8% (P＜0.05).Inner diameter of portal vein and the right branch of portal vein on the 6th and 12th month before and after operation were respectively (13.5±1.7) mm,(9.8±2.0) mm,(10.5±2.2) mm,(11.2±1.2) mm,(8.1 ± 1.3) mm and (8.2 ± 2.2) mm (P ＜ 0.05).Maximum flow rate and blood flow of portal vein,velocity of the left of portal vein in the 6th and 12th month were respectively (13.6 ±2.6) cm/s,(1095 ±290) ml/min,(13.3±2.6) cm/s,(11.5 ±1.6) cm/s,(11.8 ±1.8) cm/s,(847 ±249) ml/min,(907 ± 310) ml/min,(11.0 ± 1.9) cm/s and 11.1 ± 1.9 cm/s (P ＜ 0.05).Velocity of the right of portal vein in the sixth month were (11.6 ± 2.6) cm/s,which was significantly slower than preoperative level of (13.2 ± 2.9) cm/s. Conclusion After the Hassab surgical operation the degree of esophageal varices lightens during 18 months and aggravates after 18 months.There is obvious relation between gastric varices and the degree of esophageal varices.Velocity of portal blood flow becomes slow,blood flow diminishes and inner diameter reduces after the Hassab surgical operation.
