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脾切除门奇静脉断流术后肝固有动脉及门静脉的血流动态变化特征
DOI: 10.3969/j.issn.1001-5256.2023.01.016
伦理学声明：本研究方案于2018年2月12日经由首都医科大学附属北京佑安医院伦理委员会审批，批号：京佑科伦字[2018]006号。
利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明：赵晓飞、曾道炳、栗光明对研究的思路或设计有关键贡献；郭庆良、邸亮、丁兢参与起草或修改文章关键内容。
Hemodynamic characteristics of proper hepatic artery and portal vein in patients after splenectomy and devascularization
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摘要:
目的 了解脾切除门奇静脉断流术后肝固有动脉、门静脉的血流动态变化规律。 方法 回顾性分析首都医科大学附属北京佑安医院2014年4月—2019年2月收治的103例门静脉高压症行脾切除门奇静脉断流术患者的临床资料，记录患者术前和术后1周、1个月、3个月、6个月、12个月、24个月肝固有动脉、门静脉血流动力学变化数据，进行术前和术后资料对比，分析术前和术后各时间点肝血流变化特征。计量资料符合正态分布时采用配对样本t检验分析术前、术后各指标的差异。 结果 脾切除门奇静脉断流术后1周、1个月、3个月、6个月、12个月、24个月患者门静脉内径、门静脉流量、门静脉最大流速和平均流速较术前显著下降(P值均＜0.05)；肝固有动脉流量、流速在术后1周及术后1个月较术前显著增加(P值均＜0.05)，术后3个月、6个月、12个月、24个月则与术前无显著差异(P值均＞0.05)。 结论 脾切除门奇静脉断流术后门静脉内径、流速、流量较术前明显减低，肝固有动脉流速、流量在术后1个月内增加，术后3个月恢复至术前水平。 -
关键词:
- 肝硬化 /
- 高血压, 门静脉 /
- 脾切除门奇静脉断流术 /
- 血流动力学
Abstract:Objective To investigate the characteristics of hemodynamics of proper hepatic artery and portal vein after splenectomy and devascularization. Methods The clinical data of 103 patients with portal hypertension who underwent splenectomy and devascularization in the Capital Medical University-Affiliated You'an Hospital from April 2014 to February 2019 were retrospectively analyzed. Their hemodynamics of the proper hepatic artery and portal vein were recorded before and 1 week-, and 1-, 3-, 6-, 12-, and 24-months after surgery and then statistically analyzed. Continuous data with normal distribution were compared using paired-samples t test. Results Compared with the before surgery data, the portal vein diameter, portal vein flow, maximum velocity, and average velocity of the portal vein were all significantly decreased 1-week-, 1-, 3-, 6-, 12-, and 24-months after splenectomy and devascularization (all P < 0.05). The blood flow and velocity of the proper hepatic artery was significantly increased 1 week and 1 month after surgery (all P < 0.05); however, there was no statistically significant difference at 3-, 6-, 12-, and 24-months after surgery. Conclusion The diameter, flow, and flow velocity of the portal vein after splenectomy and devascularization were significantly lower than those before surgery, whereas the proper hepatic artery flow and flow velocity were increased within 1 month after surgery and then returned back to the pre-surgery levels 3 months after surgery. -
Key words:
- Liver Cirrhosis /
- Hypertension, Portal /
- Splenectomy and Devascularization /
- Hemodynamics
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表 1 患者术前一般资料
Table 1. Patient demographic and baseline characteristics
项目 数值 年龄(岁) 47.6±9.4 性别(例) 男 67 女 29 病因(例) 乙型肝炎肝硬化 66 丙型肝炎肝硬化 12 酒精性肝硬化 11 原发性胆汁性胆管炎 5 自身免疫性肝病 2 Child-Pugh分级(例) A 68 B 24 C 4 
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表 2 术前、术后门静脉压力及肝功能变化
Table 2. Comparison of portal vein pressure and liver function at baseline and postoperatively in liver cirrhosis patients
项目 术前 术后 统计值 P值 门静脉压力(cmH2O) 36.1±4.1 23.9±3.9 t=14.99 < 0.001 TBil (μmol/L) 21.5±9.2 15.2±6.6 t=5.33 < 0.001 Alb (g/L) 36.9±3.7 35.5±1.8 t=2.20 0.027 PT (s) 13.9±2.0 16.2±5.7 t=-6.70 < 0.001 Child-Pugh分级(A/B/C) 68/24/4 69/24/3 χ2=4.00 0.407
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表 3 术前和术后1周肝血流情况比较
Table 3. Comparison of hepatic hemodynamics at baseline and 1 week postoperation in liver cirrhosis patients
项目 例数 术前 术后1周 t值 P值 门静脉内径(mm) 89 12.79±1.50 12.19±1.60 3.13 0.003 门静脉流量(mL) 89 1 533.01±125.48 1 088.15±136.65 6.16 ＜0.001 门静脉最大流速(cm/s) 89 24.65±4.33 18.92±4.67 4.62 ＜0.001 门静脉平均流速(cm/s) 89 19.50±6.30 15.19±4.32 5.08 ＜0.001 肝动脉内径(mm) 89 3.76±0.48 3.93±0.85 -2.35 0.019 肝动脉流量(mL) 89 230.01±37.13 358.52±76.20 -4.23 ＜0.001 肝动脉最大流速(cm/s) 89 62.32±18.47 94.30±22.16 -5.84 ＜0.001 肝动脉最小流速(cm/s) 89 17.96±6.14 31.36±6.70 -5.78 ＜0.001
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表 4 术前和术后1个月肝血流情况比较
Table 4. Comparison of hepatic hemodynamics at baseline and 1 month postoperation in liver cirrhosis patients
项目 例数 术前 术后1个月 t值 P值 门静脉内径(mm) 81 12.77±1.53 12.37±2.09 1.499 0.141 门静脉流量(mL) 81 1 577.28±190.48 940.82±142.27 5.514 ＜0.001 门静脉最大流速(cm/s) 81 25.49±8.96 16.58±5.43 5.490 ＜0.001 门静脉平均流速(cm/s) 81 19.84±3.96 13.61±5.01 4.870 ＜0.001 肝动脉内径(mm) 81 3.76±0.47 3.87±0.45 -1.055 0.298 肝动脉流量(mL) 81 230.34±59.97 276.48±66.07 -2.691 0.028 肝动脉最大流速(cm/s) 81 62.51±19.66 71.62±12.84 -2.199 0.042 肝动脉最小流速(cm/s) 81 18.25±6.05 23.18±4.28 -3.393 0.002
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表 5 术前、术后3个月肝血流情况比较
Table 5. Comparison of hepatic hemodynamics at baseline and 3 month postoperation in liver cirrhosis patients
项目 例数 术前 术后3个月 t值 P值 门静脉内径(mm) 79 12.88±1.62 12.16±1.71 2.55 0.016 门静脉流量(mL) 79 1 497.90±161.76 1 030.76±174.13 3.70 0.001 门静脉最大流速(cm/s) 79 23.27±4.12 16.99±4.97 4.25 ＜0.001 门静脉平均流速(cm/s) 79 18.15±4.85 14.27±4.67 -3.23 0.003 肝动脉内径(mm) 79 3.79±0.47 3.85±0.43 -0.68 0.502 肝动脉流量(mL) 79 230.90±47.13 201.68±36.45 1.27 0.213 肝动脉最大流速(cm/s) 79 61.10±18.07 58.51±16.63 0.62 0.535 肝动脉最小流速(cm/s) 79 18.60±6.36 17.09±5.29 1.07 0.292
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表 6 术前、术后6个月肝血流情况比较
Table 6. Comparison of hepatic hemodynamics at baseline and 6 month postoperation in liver cirrhosis patients
项目 例数 术前 术后6个月 t值 P值 门静脉内径(mm) 77 12.89±1.49 12.09±1.87 2.59 0.015 门静脉流量(mL) 77 1 568.64±220.48 933.00±182.94 4.17 0.002 门静脉最大流速(cm/s) 77 23.92±7.21 17.73±5.39 3.83 0.001 门静脉平均流速(cm/s) 77 18.91±7.21 14.75±4.72 2.92 0.006 肝动脉内径(mm) 77 3.65±0.47 3.95±0.49 -2.69 0.012 肝动脉流量(mL) 77 218.33±17.13 219.05±46.11 -0.04 0.962 肝动脉最大流速(cm/s) 77 63.15±8.50 66.86±20.83 -0.74 0.460 肝动脉最小流速(cm/s) 77 17.82±5.65 18.90±7.92 -0.65 0.519
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表 7 术前、术后12个月肝血流情况比较
Table 7. Comparison of hepatic hemodynamics at baseline and 12 month postoperation in liver cirrhosis patients
项目 例数 术前 术后12个月 t值 P值 门静脉内径(mm) 64 12.83±1.62 11.96±1.10 3.11 0.004 门静脉流量(mL) 64 1 649.60±123.48 937.64±181.42 4.32 ＜0.001 门静脉最大流速(cm/s) 64 25.63±4.17 18.19±4.73 4.14 ＜0.001 门静脉平均流速(cm/s) 64 19.84±3.78 15.45±4.13 3.09 0.005 肝动脉内径(mm) 64 3.71±0.44 3.73±0.50 -0.13 0.895 肝动脉流量(mL) 64 210.82±55.06 202.97±71.50 0.35 0.729 肝动脉最大流速(cm/s) 64 60.89±10.22 64.19±11.92 -0.88 0.386 肝动脉最小流速(cm/s) 64 17.90±4.26 17.16±5.21 0.511 0.613
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表 8 术前、术后24个月肝血流情况比较
Table 8. Comparison of hepatic hemodynamics at baseline and 24 month postoperation in liver cirrhosis patients
项目 例数 术前 术后24个月 t值 P值 门静脉内径(mm) 60 12.72±1.23 11.23±1.44 2.44 0.016 门静脉流量(mL) 60 1 554.73±171.48 910.47±122.28 2.47 0.015 门静脉最大流速(cm/s) 60 21.22±4.96 15.21±3.73 3.32 0.001 门静脉平均流速(cm/s) 60 19.16±3.08 14.55±3.23 2.82 0.006 肝动脉内径(mm) 60 3.70±0.45 3.66±0.44 0.12 0.906 肝动脉流量(mL) 60 224.91±17.70 219.33±16.33 -0.08 0.934 肝动脉最大流速(cm/s) 60 63.98±10.68 64.58±19.00 -0.37 0.706 肝动脉最小流速(cm/s) 60 19.40±6.78 18.09±7.42 -0.46 0.651
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