论文部分内容阅读
[目的]观察经颈静脉肝内门体分流术(Transjugular intrahepatic portosystemic shunt,TIPS)对肝硬化门脉高压症患者门脉血流动力学的影响,探讨TIPS治疗肝硬化门脉高压症的有效性及机制。[方法]30例肝硬化门脉高压症患者,TIPS术前及术后,彩色多普勒超声测量门脉主干压、内径、血流速度及脾静脉内径。放射免疫法测定血浆肾素(PRA)、血管紧张素Ⅱ(ATⅡ)和血管内皮素(ET)浓度。[结果]30例患者术后的门脉压(24.8±3.6)cmH2O(1 cmH2O=0.098 kPa)与术前的(44.6±5.8)cmH2O比较;门脉内径(1.28±0.06)cm与术前的(1.65±0.09)cm比较;门脉血流速度(43.5±13.2)cm/s与术前的(11.6±3.8)cm/s比较;脾静脉内径(0.92±0.06)cm与术前的(1.24±0.04)cm比较,均P<0.01。血浆ET、PRA、ATⅡ浓度分别为(84.52±28.15)、(89.92±35.46)、(159.65±62.42)ng/L,与术前的(126.25±40.36)(、186.32±68.74)、(253.48±106.57)ng/L比较,均P<0.01。术后腹水较术前明显减少。[结论]TIPS能有效降低门脉压,降低血浆ET、PRA及ATⅡ的浓度,改善患者门脉系统及全身的血循环。
[Objective] To observe the effect of transjugular intrahepatic portosystemic shunt (TIPS) on portal hemodynamics in cirrhotic patients with portal hypertension and to explore the effectiveness of TIPS in treating cirrhosis and portal hypertension And mechanism. [Method] Thirty patients with cirrhosis and portal hypertension, before TIPS and after operation, the portal pressure, internal diameter, blood flow velocity and internal diameter of splenic vein were measured by color Doppler sonography. The levels of plasma renin (PRA), angiotensin Ⅱ (AT Ⅱ) and endothelin (ET) were determined by radioimmunoassay. [Results] The portal vein pressure (24.8 ± 3.6) cmH2O (1 cmH2O = 0.098 kPa) in 30 patients was significantly higher than that in preoperative (44.6 ± 5.8) cmH2O. The diameter of portal vein (1.28 ± 0.06 cm) (1.65 ± 0.09) cm; portal vein blood flow velocity (43.5 ± 13.2) cm / s compared with preoperative (11.6 ± 3.8) cm / s; ± 0.04) cm, all P <0.01. The levels of plasma ET, PRA and ATⅡ were (84.52 ± 28.15), (89.92 ± 35.46) and (159.65 ± 62.42) ng / L, respectively, which were significantly lower than those of the preoperative ones (126.25 ± 40.36 and 186.32 ± 68.74 and 253.48 ± 106.57 ) ng / L, all P <0.01. Postoperative ascites significantly reduced compared with preoperative. [Conclusion] TIPS can effectively reduce portal pressure, decrease the concentration of plasma ET, PRA and ATⅡ, and improve the blood circulation of the portal system and the whole body.