关键词: 肝硬化, 门脉高压症, 改良的Sugiura术, 门脉血流动力学

Abstract: Objective To investigate the effect of modified Sugiura’s operation on portal hemodynamics in cirrhotic patients with portal hypertension（PH）.Methods 56 cirrhotic patients with PH were admitted to our hospital between May 2013 and May 2015，and all patients received modified Sugiura’s operation. The free portal pressure （FPP） was measured before and after the operation. The hepatic reserve function was evaluated by indocyanine green 15-minute retention rate （ICGR15） and the effective liver blood flow （ELBF） was calculated. The portal vain diameter，portal vain blood flow （PVF），hepatic artery flow （HAF） and total hepatic flow （THF） were measured 1 week before，and 1 month and 3 months after devascularization surgery by ultrasonography.Results The modified Sugiura operation succeeded in this 56 patients with PH，and some complications，such as pulmonary infection and pleural effusion，wound infection，portal vein thrombosis，anastomotic stenosis and gastric fistula，etc，occurred，and all patients recovered after appropriate symptomatic，nutritional supports，antibiotics，albumin supplementation or plasma transfusion; the FPP after operation was （21.3±3.4）cmH2O，much lower than that before operation 【（32.5±5.0）cmH2O，P<0.05】；the EHBF，THF and PVF after operation were（0.5±0.1） ml/min，（1481.1±354.0） ml/min and（1046.1±258.0） ml/min，and they were（0.5±0.3） ml/min，（1574.1±326.0） ml/min and（1131.0±304.1） ml/min three months after operation，respectively，all significantly lower than those before operation [（0.7±0.3）ml/min，（1891.0±392.1） ml/min and（1523.1±291.1） ml/min，respectively，P<0.05]；the HAF after operation was （435.0±142.1）ml/min，and it was（443.0±183.1）ml/min three months after operation，both significantly higher than that before operation【（368.1±139.1） ml/min，P<0.05】；the ICGR15 after operation was （22.7±7.9）%，much higher than （19.3±5.5）% before operation（F=7.327，P<0.05）；the changes of portal vain diameters before and after operation were not significantly different（P>0.05）；at the end of one month and three months after operation，serum albumin levels increased obviously【（35.2±2.3） g/L and（36.8±1.7） g/L vs.（31.8±1.7）g/L before operation，P<0.05】；at the end of one month，peripheral platelet counts and white blood cell counts were （144.5±7.2）×109/L and （13.8±0.6）×109/L，and they were （98.1±10.6）×109/L and （4.2±0.8）×109/L three months after operation，both significantly higher than those before operation 【（75.3±6.7）×109/L and （3.4±0.3）×109/L，respectively，P<0.05】. Conclusion The application of modified Sugiura’s operation might improve liver function and portal-hepatic hemodynamics，reduce the portal pressure in patients with cirrhosis complicated with PH，which might decrease the morbidity and mortality of gastrointestinal bleeding.

Key words: Liver cirrhosis, Portal hypertension, Modified Sugiura's surgery, Portal vain, Hemodynamics