脾动脉门静脉吻合联合完全门体分流对犬门脉高压症的治疗观察

目的为评估门静脉脾动脉化对门脉高压症的治疗效果,对丝线栓塞性门脉高压模型犬进行脾动脉门静脉吻合联合完全门体分流(PACS术),并观察治疗效果。方法对门脉高压犬采用脾切除、门静脉(入肝段)-脾动脉吻合、门静脉(远肝段)-腔静脉吻合。测定入肝门脉、入下腔门脉血流、压力;门静脉、肠系膜上静脉的内径、最大血流速度、血流方向;观察手术前后肝功能变化,肝脏蛋白质合成变化。结果术后向肝门脉流量(PVF)上升至原来的180%,向肝门静脉压(PVP)上升至原来的196%,门静脉入下腔门脉血流量增至原先的130%,而压力降至原来的45.5%,均具有极为显著的统计学差异(P<0.01)。术后3周末肝功能指标和蛋白合成与术前比较,改变不明显,无统计学差异。结论PACS手术成功率较高,术后死亡率低,可同时提高入肝血流和降低侧支压力,是一种值得尝试和进一步研究的新手术方法。

The therapeutic effects of portal aterialization and complete shunt in portal hypertension dogs

Objective In order to investigate the therapeutic effects of portal arterialization for portal hypertension,portal arterialization and complete shunt(PACS) was applied in canine model of portal hypertension,which was made by thread embolization within the portal vein.Methods A splenectomy,splenic artery and upper portal vein anastomosis,and a complete portal-caval shunt were performed on portal hypertension dogs.The blood pressure and flow of the portal vein including that towards the liver and towards the vena cava were observed.Results The postoperative hepatic inflow,PVF,increased to 180% of the former while PVP increased to 196%;the caval-inflow PVF increased to 130% of the former while PVP decreased to 45.5%.Significant difference existed(P<0.01).The hepatic function changed little after the operation without any statistic difference.Conclusion PACS can significantly increase the hepatic inflow and decrease the blood pressure of the portal system with a satisfactory dog survival.It may be a worthy attempt in the treatment of portal hypertension and needs more research work.