| OBJECTIVE: In the article we want to know the changes in hepatic hemodynamics of portal vein after orthotopic liver transplantation (OLT) for liver cirrhosis and wheather the changes of hemodynamics is normal and when and which can influence it. We also master the portal pressure changes about portal hypertension before and after OLT.PATIENTS AND METHODS:We'choose 50 patients with liver cirrhosis who had undergone OLT at Transplantation Department of Tianjin First Central Hospital from November 2005 to Januvery 2006. The patients's mean age is 52.5±10.7 years . We observe some parameters related to portal hemodynamics before and after OLT by color duplex doppler ultrasound , which include portal vein velocity , portal vein diameter , spleenic vein velocity , spleenic vein diameter , hepatic artery velocity , and size of spleen . We also observe the changes of blood routine caused by hypersplenism after OLT . The varices of esophagus and stamock are observed through endoscopy and upper gastrointestinal contrast before and after OLT . In the operation we observe the portal pressure changes through a tube to right gastroepiploic vein by pressure sensor . And there are 24 normal persons for controls whose age and sex are similar to the patients . We observe one month after the operation in our research .RESULTS:The patients's diameters of portal vein and splenic vein are wider before OLT in patients than in the controls , and velocity is lower . The portal vein flow is lower in the patients than in the controls , but the splenic vein flow and diameter of spleen are higher than controls (P<0.01). The diameters of portal and splenic vein are narrower in one month after OLT than before , but they still wider than the control . After OLT the portal vein flow significantly increased , as two times asbefore operation and 1.5 times as control . The splenic vein flow is consistently higher , just four to five times than controls . The portal vein pressure is 24.57±6.22mmHg (13~36mmHg), which is higher than normal (9~15mmHg) at the beginning of the operation . And the pressure can be high to 43.14±10.21mmHg (24~80mmHg) when the cava vein is clamped . In most time of operation the portal vein pressure is significantly different with beginning (P<0.01) . Before we close the abdomen, the pressure decrease to 16.81±5.03mmHg , but they still higher than controls . The portal vein pressure decrease consistently from the neograft opening (P<0.05) . In our research the portal pressure is correlated without tumor, bleeding of digestive tract , varices degree of esophagus and stomach , weight of patient's liver and donor, collateral circulation , with portal thrombosis, central vein pressure , mean artery pressure partly . In all patients we have ligated 8 shunting varices which diameters are bigger than lcm . On the time ligated the pressure increase 0~llmmHg (4.00±4.14mmHg) which is higher than before ligation (P =0.029) . The varices of esophageal and gastric remission rate is totally 95.5% . After OLT the size of spleen decrease significantly (P<0.01) , but still bigger than controls (2.88±0.51cm) in one month after operation . In blood the WBC count and PLT count changes most quickly , and they can be normal in early after OLT (P<0.05) , yet RBC and HGB don't change so much .CONCLUSIONrAfter OLT the hemodynamics of portal vein system with hyperkinetic and high flow volume is consistently higher than controls and it can't be normal in early . The size of spleen and splenic vein flow is abnormal in a long time , but WBC count and PLT count in blood change quickly after OLT. The portal vein pressure changes significantly in the operation and it decreases a lot to normal level in 2-4 hours after operation . Only few factors have the relationship with portalpressure . In our research we can also conclude that the pressure monitoring by pressure sensor is one safe , accurate , real time way to reflect the hepatic pressure. |
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