CAJ | 학술논문

目的观察肝侧门静脉-肝总动脉侧端分流术和侧侧分流术(统称门肝分流术)对猪肝硬化门脉高压症动物模型的治疗效果.方法对照组和实验组(即肝硬化门脉高压模型组)实验猪各15头分别行门肝分流术,观察门静脉血入肝及降压的过程.结果对照组和实验组门肝分流术前门静脉压力分别为(20.51±0.74) cm H2O(1 cm H2O=0.098 kPa)和(30.82±2.53)cm H2O(P＜0.05)；术后30 d分别为(19.75±0.84) cm H2O和(20.84±1.36) cm H2O(P＞0.05).对照组和实验组门静脉与肝总动脉的压力差术前分别为(7.20±0.34) cm H2O和(17.34±0.62) cm H2O(P＜0.05)；术后30 d分别为(6.40±0.21) cm H2O和(7.84±1.32) cm H2O(P＞0.05).分流后术中脾静脉注射亚甲蓝肝脏染色良好.术后观察30 d无肝坏死及肝性脑病发生,脾肿大恢复正常.门肝分流术对肝功能的影响较大,对其他血生化代谢指标影响较小.结论门肝分流术后虽然门静脉血入肝通道发生变更,但门脉血流动力学并未受到显著影响,反而建立了新的平衡机制来维持门脉血流动力学的稳定,达到门脉降压效果.门肝分流术后肝功能恢复所需时间较长,且需进一步治疗.
목적 관찰간측문정맥-간총동맥측단분류술화측측분류술(통칭문간분류술)대저간경화문맥고압증동물모형적치료효과.방법 대조조화실험조(즉간경화문맥고압모형조)실험저각15두분별행문간분류술,관찰문정맥혈입간급강압적과정.결과 대조조화실험조문간분류술전문정맥압력분별위(20.51±0.74) cm H2O(1 cm H2O=0.098 kPa)화(30.82±2.53)cm H2O(P＜0.05)；술후30 d분별위(19.75±0.84) cm H2O화(20.84±1.36) cm H2O(P＞0.05).대조조화실험조문정맥여간총동맥적압력차술전분별위(7.20±0.34) cm H2O화(17.34±0.62) cm H2O(P＜0.05)；술후30 d분별위(6.40±0.21) cm H2O화(7.84±1.32) cm H2O(P＞0.05).분류후술중비정맥주사아갑람간장염색량호.술후관찰30 d무간배사급간성뇌병발생,비종대회복정상.문간분류술대간공능적영향교대,대기타혈생화대사지표영향교소.결론 문간분류술후수연문정맥혈입간통도발생변경,단문맥혈류동역학병미수도현저영향,반이건립료신적평형궤제래유지문맥혈류동역학적은정,체도문맥강압효과.문간분류술후간공능회복소수시간교장,차수진일보치료.
Objective To observe the therapeutic effects of end-to-side and side-to-side portal vein-hepatic artery shunts (P-H shunt) in pigs with liver cirrhosis and portal hypertension.Methods There were 15 pigs in each group (control and experimental),and the P-H shunt was made in each animal to observe the process of blood flow into the liver and the reduction of portal vein blood pressure.Results The portal vein pressures before the P-H shunt of pigs in the control and experimental group were (20.51±0.74) cm H2O (1 cm H2O=0.098 kPa) and (30.82±2.53) cm H2O respectively (P＜0.05).Portal vein pressures 30 days after the P-H shunt were(19.75±0.84) cm H2O and (20.84± 1.36) cm H2 O respectively (P＞0.05).The portal vein pressure differences of pigs in the control and experimental group before P-H shunt were (7.20±0.34) cm H2O and (17.34±0.62) cm H2O respectively (P＜0.05).Pressures differences 30 days after the P-H shunt were (6.40±0.21) cm H2O and (7.84 ± 1.32) cm H2O respectively (P＜0.05).Splenic vein injection of methylene blue after the P-H shunt operation stained the liver well.No necrosis and hepatic encephalopathy occurred for 30 days after the P-H shunt,and the splenomegaly gradually returned to normal.Liver function was most affected after the operation and other biochemical markers were least affected.Conclusions The P-H shunt changed the channel of blood flow into the liver,the portal hemodynamic was not affected,and a new balanced mechanism was established to maintain the portal hemodynamic stability.However,further treatment was needed for liver function recovery.