CAJ | 학술논문

目的探讨肝流出静脉通畅性对腔房转流术(atrial caval shunting,ACS)治疗布加综合征(Budd-Chiari syndrome,BCS)术后门静脉高压症疗效及人工血管通畅率的影响.方法回顾性分析自1992年1月至2010年1月河南省人民医院应用ACS治疗的209例BCS患者的临床资料,分为肝流出静脉通畅组(A组)及肝流出静脉狭窄组(B组),检测术中开放人工血管前后自由门静脉压力(free portal pressure,FPP)变化,观察术后门静脉血流速度、肝脏功能、脾脏体积和功能、胃底食管静脉曲张程度的变化以及术后人工血管通畅情况.结果人工血管开放后A组FPP下降幅度高于B组(t=10.45,P＜0.05).术后2周时复查彩超A组门静脉血流速度较术前明显增快、且高于B组(t=12.81,P ＜0.05).术后A组Child-Pugh肝功能评分及肝功能储备试验R15的下降幅度、外周血三系细胞升高幅度及脾脏缩小程度均下降并高于B组(P＜0.05).A组患者的胃底食管静脉曲张缓解情况优于B组(x2 =44.73,P＜0.05).A组患者术后人工血管通畅率优于B组患者(P＜0.05).结论肝流出静脉直径对ACS治疗BCS术后缓解门静脉高压有影响,且与术后人工血管通畅率有关系.
목적 탐토간류출정맥통창성대강방전류술(atrial caval shunting,ACS)치료포가종합정(Budd-Chiari syndrome,BCS)술후문정맥고압증료효급인공혈관통창솔적영향.방법 회고성분석자1992년1월지2010년1월하남성인민의원응용ACS치료적209례BCS환자적림상자료,분위간류출정맥통창조(A조)급간류출정맥협착조(B조),검측술중개방인공혈관전후자유문정맥압력(free portal pressure,FPP)변화,관찰술후문정맥혈류속도、간장공능、비장체적화공능、위저식관정맥곡장정도적변화이급술후인공혈관통창정황.결과 인공혈관개방후A조FPP하강폭도고우B조(t=10.45,P＜0.05).술후2주시복사채초A조문정맥혈류속도교술전명현증쾌、차고우B조(t=12.81,P ＜0.05).술후A조Child-Pugh간공능평분급간공능저비시험R15적하강폭도、외주혈삼계세포승고폭도급비장축소정도균하강병고우B조(P＜0.05).A조환자적위저식관정맥곡장완해정황우우B조(x2 =44.73,P＜0.05).A조환자술후인공혈관통창솔우우B조환자(P＜0.05).결론 간류출정맥직경대ACS치료BCS술후완해문정맥고압유영향,차여술후인공혈관통창솔유관계.
Objective To investigate the influence of diameter of liver outflow vein on portal hypertension and artificial blood vessel (ABV) patency rate in Budd-Chiari syndrome (BCS) patients undergoing atrial caval shunting (ACS).Methods We recruited 209 patients,who had undergone ACS for Ⅱ type of BCS.Those patients with unobstructed liver outflow vein were included into group A and the patients with stenosed liver outflow vein into group B.Free portal pressure (FPP) was measured before and after ABV opening.Portal vein velocity (Vpv),liver function,spleen volume and function,esophagogastric varices and ABV patency were evaluated postoperatively.Results After ABV opening,FPP decreased significantly in group A than group B (t =10.45,P ＜ 0.05).Vpv accelerated significantly in group A 2 weeks after operation than group B (t =12.81,P ＜ 0.05).Apparent improvement of liver function,spleen function and esophagogastric varices and reduction of spleen volume were observed in group A patients than group B patients (P ＜ 0.05).Reduction of esophagogastric varices in group A was better than in group B (x2 =44.73,P ＜ 0.05).By postoperative follow up,ABV patency of group A was higher than group B (P ＜ 0.05).Conclusions Patency status of liver outflow vein significantly influences postoperative portal vein pressure and closely correlats to ABV patency rate after ACS.