本文選題：肝硬化　切入點(diǎn)：門靜脈高壓　出處：《遵義醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：探討肝硬化門靜脈高壓與肝動(dòng)脈、脾動(dòng)脈間的血流動(dòng)力學(xué)關(guān)系，為肝化門靜脈高壓患者探索新的診療方法提供依據(jù)；觀察肝硬化門靜脈高壓伴脾亢患者部分性脾動(dòng)脈栓塞（PSE）術(shù)前及術(shù)后1周肝動(dòng)脈、脾動(dòng)脈及門靜脈系統(tǒng)血流動(dòng)力學(xué)變化，探討PSE對(duì)肝硬化門靜脈高壓治療的影響。 方法：42例肝硬化門靜脈高壓伴脾亢患者接受PSE治療，利用彩色多普勒超聲(CDU)分別于PSE術(shù)前及術(shù)后1周對(duì)肝動(dòng)脈、脾動(dòng)脈、脾靜脈及門靜脈血流動(dòng)力學(xué)指標(biāo)進(jìn)行檢測，主要檢測指標(biāo)包括：肝動(dòng)脈、脾動(dòng)脈、脾靜脈及門靜脈血管內(nèi)徑、血流速度、血流量和血管阻力。另選取88例健康對(duì)照組，同樣采用彩色多普勒超聲檢測肝動(dòng)脈、脾動(dòng)脈、脾靜脈及門靜脈血流動(dòng)力學(xué)相應(yīng)指標(biāo)。觀察肝硬化門靜脈高壓伴脾亢患者PSE術(shù)前與術(shù)后1周肝動(dòng)脈、脾動(dòng)脈及門靜脈血流動(dòng)力學(xué)指標(biāo)的變化，分析PSE對(duì)門靜脈血流的影響。 結(jié)果:門靜脈高壓伴脾亢組患者PSE術(shù)前脾動(dòng)脈、脾靜脈及門靜脈內(nèi)徑分別為（5.18±0.85）mm、（10.61±2.61）mm、（14.21±1.74）mm，平均血流速度分別為（54.96±12.86）cm/s、（19.14±6.33）cm/s、（17.31±4.65）cm/s，，平均血流量分別為（708.29±286.10）ml/min、（1156.4±82.56）ml/min、（1642.40±57.88）ml/min；對(duì)照組脾動(dòng)脈、脾靜脈及門靜脈內(nèi)徑分別為（3.56±0.44）mm、（6.00±0.60）mm、（10.60±0.97mm），平均血流速度分別為（37.43±13.14） cm/s、（18.01±3.42）cm/s、（17.91±3.51）cm/s，平均血流量分別為（231.65±114.21）ml/min、（308.34±82.12）ml/min、（959.97±261.23）ml/min。上述指標(biāo)兩組比較，P0．05，差異有統(tǒng)計(jì)學(xué)意義，門靜脈高壓伴脾亢組觀察指標(biāo)均高于健康對(duì)照組。PSE術(shù)前肝動(dòng)脈血流量（111.52±48.06）ml/min較對(duì)照組（232.85±109.66）ml/min減少，P0．05，差異有統(tǒng)計(jì)學(xué)意義；部分性脾動(dòng)脈栓塞后1周，各項(xiàng)指標(biāo)檢測值分別為：肝動(dòng)脈血流量（382.57±314.53）ml/min，脾動(dòng)脈血流量（486.56±135.68）ml/min，脾靜脈血流量（1026.62±43.59）ml/min，門靜脈血流量（1376.45±44.17）ml/min，與術(shù)前比較肝動(dòng)脈血流量增加，其余指標(biāo)均較術(shù)前減少，P0．05，差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論：肝硬化門靜脈高壓脾亢患者脾動(dòng)脈、脾靜脈血管內(nèi)徑增粗，循環(huán)血量加大，是門靜脈高壓形成血流注入的動(dòng)力因素，脾栓塞可減少脾循環(huán)血量，從而降低門靜脈壓力，同時(shí)可增加肝臟動(dòng)脈血供。
[Abstract]:Objective: to explore the hemodynamic relationship between portal hypertension and hepatic artery and splenic artery in cirrhotic patients, so as to provide basis for the diagnosis and treatment of hepatic portal hypertension. To observe the hemodynamic changes of hepatic artery, splenic artery and portal vein system before and after partial splenic artery embolization (PSE) in patients with cirrhotic portal hypertension and hypersplenism, and to investigate the effect of PSE on the treatment of cirrhosis and portal hypertension. Methods 42 patients with portal hypertension associated with hypersplenism were treated with PSE. The hemodynamic indexes of hepatic artery, splenic artery, splenic vein and portal vein were measured before and 1 week after PSE. The main parameters included: diameter of hepatic artery, splenic artery, splenic vein and portal vein, blood flow velocity, blood flow and vascular resistance. To observe the changes of hepatic artery, splenic artery and portal vein hemodynamics in patients with cirrhosis and portal hypertension with hypersplenism before and after PSE, and to analyze the influence of PSE on portal vein blood flow. Results: before PSE, the diameter of splenic artery, splenic vein and portal vein in portal hypertension with hypersplenism group were 5.18 鹵0.85 鹵0.85 鹵2.61 鹵2.61 鹵2.61 鹵1.74 mm, respectively, and the mean blood flow velocity was 54.96 鹵12.86 鹵12.86 鹵19.14 鹵6.33 cm / r 路min ~ (-1) 路min ~ (-1) respectively, and the mean blood flow was 1.708.29 鹵286.10 ml / min, 1156.4 鹵82.56 ml / min / min, 1642.40 鹵57.88 ml / min, respectively; in the control group, the mean blood flow was 1142.40 鹵57.88 ml / min; in the control group, the mean blood flow was 115.29 鹵286.10ml / min and 1642.40 鹵57.88ml / min, respectively. The internal diameters of splenic vein and portal vein were 6.00 鹵0.60 鹵0.60 鹵0.97 鹵10.60 鹵0.97 mm, respectively. The mean blood flow velocity was 37.43 鹵13.14) cm / s, respectively 18.01 鹵3.42 鹵3.42 鹵17.91 鹵3.51 cm / s, and the mean blood flow was 231.65 鹵114.21 / ml / min, 308.34 鹵82.12ml / min, 959.97 鹵261.23ml / min, respectively. The difference between the two groups was statistically significant. The observed indexes of portal hypertension with hypersplenism were significantly higher than those of the control group (111.52 鹵48.06)ml/min) and the control group (232.85 鹵109.66)ml/min) (P 0.05), the difference was statistically significant (P 0.05), 1 week after partial splenic artery embolization, and 1 week after partial splenic artery embolization, there was no significant difference between the two groups. The measured values were as follows: hepatic arterial blood flow was 382.57 鹵314.53 ml / min, splenic artery blood flow was 486.56 鹵135.68 ml / min, splenic vein blood flow was 1026.62 鹵43.59 ml / min, portal vein blood flow was 1376.45 鹵44.17 ml / min, compared with pre-operation, hepatic arterial blood flow increased, and other indexes decreased (P 0.05). Conclusion: splenic artery in patients with hypersplenism due to portal hypertension in liver cirrhosis, the diameter of splenic vein and the volume of circulating blood are increased. Splenic embolization can reduce the volume of splenic circulation and decrease the pressure of portal vein. At the same time, it can increase hepatic arterial blood supply.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R575.2;R445.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 邢金子;劉愛連;王藝;董越;寧殿秀;;1.5T磁共振插入有限脈沖響應(yīng)技術(shù)對(duì)肝硬化門脈系統(tǒng)改變的初探[J];磁共振成像;2011年05期

2 王曉峰;黃新余;;肝硬化門靜脈高壓癥的血流動(dòng)力學(xué)檢查及其臨床意義[J];肝膽胰外科雜志;2010年02期

3 韓春宏;姚偉根;張建豐;楊漢卿;;MSCT門靜脈造影和內(nèi)鏡對(duì)食管靜脈曲張分級(jí)的對(duì)照研究[J];放射學(xué)實(shí)踐;2013年02期

4 張碩;余繼海;許戈良;;門靜脈高壓癥血流動(dòng)力學(xué)研究進(jìn)展[J];肝膽外科雜志;2013年03期

5 劉全達(dá);宋揚(yáng);喬海泉;;脾動(dòng)脈盜血綜合征—被忽視的概念[J];局解手術(shù)學(xué)雜志;2011年01期

6 徐家華;李茂全;;部分脾動(dòng)脈栓塞術(shù)治療肝炎肝硬化脾功能亢進(jìn)[J];介入放射學(xué)雜志;2009年02期

7 張新元;耿惠杰;王寶才;張新方;杜瑞清;王立靜;尹書梅;;部分脾栓塞術(shù)治療肝硬化門脈高壓癥肝、脾血流動(dòng)力學(xué)遠(yuǎn)期變化[J];介入放射學(xué)雜志;2009年08期

8 宋兵;李彩英;劉增品;趙林;白文元;;胃左靜脈MSCTA預(yù)測肝硬化門靜脈高壓食管胃底靜脈曲張破裂\

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