| Objective: To study the hemodynamic characteristics of portal hypertension, and the hemodynamic after splenectomy plus disconnection of pericardial vascular, and further understanding the pathogenesis of portal hypertension, to understanding the hemodynamic impact to portal vein and hepatic artery after splenectomy plus disconnection of pericardial vascular surgery, and to provide more scientific guidelines for the treatment of portal hypertension.Method:1 Object of study1.1 Case groupWe chose 9 cases of male patients undergoing surgery for portal hypertension in Hepatobiliary Surgery of our hospital from October 2010 to February 2011. They were from 44 to 64 years old, and the average age was (55±7) years, and the median age was 56 years. All of them had got cirrhosis after Hepatitis B, and their liver function were all Child-Pugh A. All the 9 patients had preoperative history of hematemesis and melena, but nearly a month without bleeding. All patients had moderate or severe esophageal varices confirmed by upper gastrointestinal barium meal or gastroscopy before surgery. The surgical method was splenectomy plus disconnection of pericardial vascular surgery.1.2 Control group was composed with 9 healthy men aged 41 to 60 years old. They average age was(52±8) years, and median age was 53 years old.2 Instruments and equipmentGE LOGIQ9 color Doppler ultrasonic diagnostic apparatus, the probe frequency was 1.9 ~ 4.0MHz.HP M1205A Electronic Monitor Edwards one pressure sensor3 Detection3.1 Portal vein, hepatic artery blood flow velocity checkwe checked homodynamic one week before and after surgery. Patients must be fasting last 12h before the test, keeping supine position for checks. Measurement points were set at 2cm away from the first hepatic portal by convex array probe with frequency in 3.5MHz. Then we made adjustment to the angle of color sampling frame according to the direction of blood flow displayed by Color Doppler, and made adjustment range according to blood flow rate. Pulsed Doppler sample volume adjusted vessel diameter measured by 2 / 3, the angle between the beam and blood flow <60°. Were measured hepatic artery and portal vein diameter, maximum velocity, minimum velocity, mean velocity and flow, observed with portal vein thrombosis. Told patients holding their breath temporarily when measurement starting. These Doppler parameters were measured by the same Ultrasound physician. Case group were exerted ultrasound examination for 2 times before and after surgery, and only once in Control group.3.2 The free portal pressure (Free portal pressure, FPP) Determination Surgery in the right gastroepiploic vein indwelling needle penetration, the connection one-time pressure sensors, the monitor read laparotomy, splenic artery ligation, splenectomy, the drying up after the free portal pressure. Only the patient group during the operation free portal pressure measurement, control group was not surgery, does not measure the free portal pressure.4 Statistical methodsData were analyzed using SPSS Statistics17 software, the result of "mean±standard deviation," said the statistical analysis using normal test, independent sample t test and paired samples t test. P <0.05 was considered statistically significant, P <0.01 as statistically significant difference.Results:1 Preoperative homodynamic of case group: hepatic artery diameter (0.34±0.01) cm, the value of 0.34cm; hepatic artery maximum flow rate (64.6±5.0) cm / s, median 64.7 cm / s; hepatic artery Minimum flow rate (18.6±0.7) cm / s, median 18.6 cm / s; hepatic artery mean flow rate (32.2±0.9) cm / s, the value of 32.3cm / s; hepatic arterial flow (178.6±8.0 ) ml / min, median 179.1 ml / min. Portal vein diameter (1.34±0.27) cm, the value of 1.39cm; portal vein maximum flow rate (28.3±2.9) cm / s, median 28.7 cm / s; portal vein lowest flow rate (20.3±4.0) cm / s, the value of 21.4 cm / s; portal vein mean flow rate (25.7±2.2) cm / s, the value of 25.8cm / s; portal vein flow (1735±358) ml / min, the value of 1788 ml / min.2 Postoperative homodynamic of case group: hepatic artery diameter (0.41±0.02) cm, the value of 0.41cm; hepatic artery maximum flow rate (88.5±6.1) cm / s, median 89.6 cm / s; hepatic artery Minimum flow rate (28.1±1.7) cm / s, the value of 28.2cm / s; hepatic artery mean flow rate (49.7±3.7) cm / s, the value of 49.6cm / s; hepatic arterial flow (381.1±66.5 ) ml / min, median 371.5 ml / min. Portal vein diameter (0.99±0.03) cm, the value of 1.00cm; maximum flow rate of the portal vein (27.5±2.5) cm / s, the value of 27.8cm / s; the minimum flow rate of the portal vein (21.2±2.3) cm / s, the was 21.6cm / s; portal vein mean flow rate (24.2±1.4) cm / s, the value of 24.5cm / s; portal vein flow (1151±69) ml / min, the value of 1150 ml / min.3 Homodynamic of control group: the hepatic artery diameter (0.43±0.01) cm, the value of 0.43cm; hepatic artery flow rate was the highest (71.0±3.5) cm / s, median 70.2 cm / s; the minimum flow rate of the hepatic artery was (19.4±1.1) cm / s, the value of 19.4cm / s; hepatic artery mean flow rate (32.3±0.77) cm / s, the value of 32.2cm / s; hepatic arterial flow (285.1±4.1) ml / min, the value of 285.2ml/min. Portal vein diameter (1.07±0.06) cm, the value of 1.07cm; maximum flow rate of the portal vein (24.7±3.1) cm / s, the value of 24.1cm / s; the minimum flow rate of the portal vein (17.3±2.4) cm / s, the was 17.5cm / s; portal vein mean flow rate (21.6±3.0) cm / s, the value of 21.4cm / s; portal vein flow (1159±138) ml / min, the value of 1143 ml / min.4 Intraoperative measurement results of free portal pressure: after laparotomy free portal pressure (29±2) mmHg, median 29 mmHg; splenic artery ligation in the free portal pressure (23±1) mmHg, median 23 mmHg; after splenectomy free portal pressure (22±1) mmHg, median 22 mmHg; stop after the free portal pressure (22±1) mmHg, median 22 mmHg.Conclusion:1 Portal hypertension can make hepatic artery flow decrease, and make portal flow increase.2 Splenectomy can reduce the portal venous pressure, and cardiac breaking of peripheral vascular surgery can improve the portal vein pressure. The change in the latter was much smaller than the former. Splenectomy plus breaking of pericardial vascular surgery can decrease portal vein pressure.3 Splenectomy plus disconnection of pericardial vascular surgery can increase the flow of the hepatic artery, and reduce portal venous flow. Total hepatic blood flow decreased after surgery, and hepatic artery blood flow share was increased. The blood flow into the liver can carry more oxygen...
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