关键词: 门静脉高压, 分流术, 肝血流量, 肝脏储备功能, 断流术

Abstract: Objective To evaluate the effects of the small diameter splenocaval shunt plus devascularization procedure on changes to hepatic hemodynamics and functional reserve in patients with portal hypertension. Methods Clinical data of 86 patients （58 underwent shunt plus devascularization procedure and 28 received devascularization procedure only） with portal hypertension of cirrhosis from Aug 2010 to Jul 2013 were analyzed retrospectively. Portal vein hemodynamics was studied by monitoring the free portal pressure （FPP） intra-operatively and color Doppler flow imaging. Hepatic functional reserve was estimated by the indo-cyanine green retention ratio at fifteen minutes（ICGR15） and the functional hepatic flow（FHF）. Clinical effects were followed-up and compared between two groups. Results In combinational therapy group,the postoperative FPP, portal venous flow（PVF）,FHF and ICGR15 were（31.4±2.4）cmH2O,（900±350） ml/min,（551±246） ml/min and （31.2±13.8）%,respectively,which were significantly different from those before operation [（38.2±3.6） cmH2O, （1250±360） ml/min,（696±300） ml/min and （23.6±11.9）%,P<0.05]. In devascularization group, the postoperative FPP,portal venous flow（PVF）,FHF and ICGR15 were （32.8±3.2） cmH2O,（980±250） ml/min,（507±140） ml/min and （27.4±13.0）%,respectively,which also different from those before operation [（36.9±3.9） cmH2O,（1320±320） ml/min,（625±158） ml/min and（22.2±13.4）%,（P<0.05）]. Compared to the devascularization group, the decrease of FPP in combinational therapy group was greater（P<0.05）,however,there were no differences in PVF,FHF and ICGR15 between the two groups. There were four （1 in combinational therapy and 3 in devascularization group） and 3 patients（2 in combinational therapy and 1 in devascularization group） experienced re-hemorrhage and encephalopathy,respectively,during postoperative follow-up. Conclusion Changes in the hemodynamics are sensible because the combined procedure would not only decrease the FPP but also maintain the portal flow to the liver,sustain the hepatic reserve and protect the liver function from the risk of liver failure. This indicates that the small diameter splenocaval shunt plus devascularization procedure is safe and effective for the treatment of portal hypertension.

Key words: Portal hypertension, Shunting, Hepatic flow, Hepatic functional reserve, Devascularization