实用肝脏病杂志 ›› 2019, Vol. 22 ›› Issue (4): 553-556.doi: 10.3969/j.issn.1672-5069.2019.04.026

• 肝硬化 • 上一篇    下一篇

采用改良的Sugiura术治疗肝硬化并发门脉高压症患者疗效研究*

张云峰, 魏瑷琳, 黄进, 周传力   

  1. 610041成都市第七人民医院肝胆外科(张云峰,黄进, 周传力);
    四川大学附属华西医院胰腺外科(魏瑷琳)
  • 收稿日期:2018-07-20 出版日期:2019-07-10 发布日期:2019-07-19
  • 作者简介:张云峰,男,35岁,大学本科,主治医师。主要从事肝胆胰脾外科学研究。E-mail: 191791018@qq.com
  • 基金资助:
    *四川省自然科学基金资助项目(编号:625848)

Effect of modified Sugiura’s operation on portal hemodynamics in cirrhotic patients with portal hypertension

Zhang Yunfeng, Wei Ailin, Huang Jin, et al   

  1. Department of Hepatobiliary Surgery,Seventh People’s Hospital,Chengdu 610041,Sichuan Province,China
  • Received:2018-07-20 Online:2019-07-10 Published:2019-07-19

摘要: 目的 探讨采用改良的Sugiura术治疗肝硬化并发门脉高压症患者的疗效及其对门脉血流动力学指标的影响。方法 回忆性分析2013年5月~2015年5月期间我院治疗的56例肝硬化并发门脉高压症患者的临床资料,手术前后采取玻璃管水柱法测量自由门静脉压(FPP),采用吲哚氰绿15分钟潴留率(ICGR15)检测肝脏储备功能,计算肝脏有效血流(ELBF),使用B超检测门脉内径、门静脉血流量(PVF)、肝动脉血流(HAF)和肝总血流量(THF)的变化。结果 经过改良的Sugiura术治疗,56例患者手术成功,出现肺部感染和胸腔积液4例,切口感染2例,门静脉血栓形成5例,吻合口狭窄4例,胃瘘1例。经充分引流、营养支持、抗感染、补充白蛋白或输注血浆等对症支持治疗,病情逐步缓解或痊愈;术后FPP水平为(21.3±3.4) cmH2O,显著低于术前水平【(32.5±5.0)cmH2O,P<0.05】;在术后,56例患者EHBF、THF和PVF水平分别为(0.5±0.1) ml/min、(1481.1±354.0) ml/min和(1046.1±258.0) ml/min,在术后3 m,分别为(0.5±0.3)ml/min、(1574.1±326.0) ml/min和(1131.0±304.1) ml/min,均显著低于术前水平 [分别为(0.7±0.3) ml/min、(1891.0±392.1) ml/min和(1523.1±291.1)ml/min,P<0.05];术后HAF水平为 (435.0±142.1) ml/min,术后3 m时为(443.0±183.1) ml/min,均显著高于术前水平【(368.1±139.1)ml/min,P<0.05】;术后患者ICGR15为(22.7±7.9)%, 显著高于术前的(19.3±5.5)%,差异显著(F=7.327,P<0.05);手术前后门静脉内径变化差异无统计学意义(P>0.05);术后1 m和术后3 m,患者血清白蛋白水平大幅升高【分别为(35.2±2.3) g/L和(36.8±1.7) g/L对(31.8±1.7) g/L,P<0.05】;在术后1 m时,患者外周血PLT和WBC计数分别为(144.5±7.2)×109/L和(13.8±0.6)×109/L,在术后3 m时则分别为(98.1±10.6)×109/L和(4.2±0.8)×109/L,均显著高于术前水平【分别为(75.3±6.7)×109/L和(3.4±0.3)×109/L,P<0.05】。结论 采用改良的Sugiura术治疗肝硬化并发门脉高压症患者能够改善肝功能、血细胞和门脉系统血流动力学指标,降低门静脉压力,对防治病情恶化和消化道出血有帮助,其远期疗效还有待观察。

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