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

【摘要】：目的：探討肝硬化門靜脈高壓與肝動脈、脾動脈間的血流動力學關系，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脈栓塞（PSE）術前及術后1周肝動脈、脾動脈及門靜脈系統(tǒng)血流動力學變化，探討PSE對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術前及術后1周對肝動脈、脾動脈、脾靜脈及門靜脈血流動力學指標進行檢測，主要檢測指標包括：肝動脈、脾動脈、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例健康對照組，同樣采用彩色多普勒超聲檢測肝動脈、脾動脈、脾靜脈及門靜脈血流動力學相應指標。觀察肝硬化門靜脈高壓伴脾亢患者PSE術前與術后1周肝動脈、脾動脈及門靜脈血流動力學指標的變化，分析PSE對門靜脈血流的影響。 結果:門靜脈高壓伴脾亢組患者PSE術前脾動脈、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；對照組脾動脈、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。上述指標兩組比較，P0．05，差異有統(tǒng)計學意義，門靜脈高壓伴脾亢組觀察指標均高于健康對照組。PSE術前肝動脈血流量（111.52±48.06）ml/min較對照組（232.85±109.66）ml/min減少，P0．05，差異有統(tǒng)計學意義；部分性脾動脈栓塞后1周，各項指標檢測值分別為：肝動脈血流量（382.57±314.53）ml/min，脾動脈血流量（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，與術前比較肝動脈血流量增加，其余指標均較術前減少，P0．05，差異有統(tǒng)計學意義。 結論：肝硬化門靜脈高壓脾亢患者脾動脈、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，同時可增加肝臟動脈血供。
[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.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R575.2;R445.1

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