中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (12): 1046-1049.

• 论著 • 上一篇    下一篇

活体肝移植术后内脏血流动力学变化临床研究

蒋水明，周光文，申    川，陈    瑞，张    强，李    风，沈柏用，陈    皓，陈拥军，彭承宏，李宏为   

  1. 上海交通大学医学院附属瑞金医院外科 上海消化外科研究所，上海200025
  • 出版日期:2010-12-01 发布日期:2010-11-25

  • Online:2010-12-01 Published:2010-11-25

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摘要：

目的    探讨门静脉高压症病人活体肝移植术后内脏血流动力学变化及其对侧支循环和术后肝功能的影响。方法    选取2006年12月至2008年6月因门静脉高压症在上海交通大学医学院附属瑞金医院行活体肝移植术18例病人，分别于术前，术后1、3、5、7d及1、3个月应用彩色多普勒超声监测病人门静脉血流平均速度（PBV）、门静脉血流量（PBF）和肝动脉阻力指数（HA-RI）变化，并与18例活体肝移植供体进行对照。应用计算机断层血管造影术分别于术后7、30和90d测量肝脏、脾脏体积大小，同时观察受体食管胃底曲张静脉变化。结果    移植术后受体组门静脉压力降低，但仍高于正常平均水平。术后PBF和PBV均明显升高，术后第1天PBF从术前（1081±278）mL/min升至（2171±613）mL/min，PBV从（15.0±5.7）cm/s升至（52.9±22.1）cm/s，其中脾动脉结扎组PBF低于不结扎组，但两组间差异无统计学意义（P＞0.05）；此后逐渐下降，但术后3个月仍高于供体组（P＜0.05）。供体组术后PBF与术前差异无统计学意义，而PBV从术前（23.7±7.2）cm/s增至（30.7±7.5）cm/s（P＜0.01），1个月后恢复正常。术后移植物和残肝均迅速再生，3个月后分别增至（1426.2±203.4）mL和（1139.3±153.1）mL。受体组术后脾脏体积明显减小，但术后3个月脾脏体积仍远大于供体术前正常水平（P＜0.01），而供体组术后脾脏体积较术前增加。术后早期食管胃底曲张静脉亦存在。结论    门静脉高压症病人活体肝移植术后门静脉血流呈高灌注状态，此变化与脾脏仍肿大有关。术后脾动脉结扎可有效预防移植物高灌注性损伤。

关键词: 门静脉高压症, 活体肝移植, 内脏血流动力学

Abstract:

Clinical study on splanchnic hemodynamic changes after living donor liver transplantation for patients with portal hypertension        JIANG Shui-ming, ZHOU Guang-wen, SHEN Chuan, et al. Department of Surgery, Shanghai Institute of Digestive  Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Corresponding author ：ZHOU Guang-wen, E-mail：gw_vrai@yahoo.com.cn
Abstract    Objective    To study the splanchnic hemodynamic changes after living donor liver transplantation (LDLT). At same time, the effect of such changes on collateral circulation and postoperative liver function was evaluated too. Methods    Between 2006 and 2008, in 18 patients with portal hypertension underwent LDLT, the following parameters were measured preoperatively and postoperative days 1, 3, 5, 7; and 1, 3 months after LDLT with Color Doppler sonography: portal blood flow volume (PBF), portal blood flow mean velocity (PBV), hepatic artery resistance indexes (HA-RI). The same parameters were measured in 18 living donors as contrast. Postoperative graft and spleen volume were estimated by computed tomography. Results    In recipient group, portal venous pressure was decreased, but was higher than normal value after LDLT. PBF and PBV increased and achieved peak value in first day after LDLT (from 1081±278 mL/min to 2171±613 mL/min and from 15±5.7 cm/s to 56±22.1 cm/s, respectively, P<0.01). Although a progressive reduction of PBF and PBV was observed during the follow-up, until 3 months after LDLT, PBF and PBV were significantly greater than donor group (P<0.05). In donor group, although PBF had no change after LDLT, PBV increased (from 23.7±7.2 cm/s to 30.7±7.5 cm/s, P<0.05), and returned to normal after 1 month. Graft and residual liver regenerated rapidly after LDLT. Graft and residual liver volume reached 1426.2±203.4mL and 1139.3±153.1mL respectively. A clear and rapid improvement in splenomegaly was presented in recipient group, whereas spleen size increased postoperative in donor group. Conclusions    A high portal flow was present in cirrhosis with portal hypertension after LDLT.The possible causes for this can be persistence of considerable splenomegaly. Splenic artery is effective management modality for preventing portal hyperperfusion injury.

Key words: portal hypertension, living donor liver transplantation, splanchnic hemodynamics