Splenomegaly and variceal bleeding--hemodynamic basis and treatment implications.
Splenomegaly and variceal bleeding--hemodynamic basis and treatment implications.
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发表时间：
1994-12
影响因子：
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通讯作者：
R. Gusberg;S. Peterec;B. Sumpio;G. Meier
中科院分区：
文献类型：
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作者：
R. Gusberg;S. Peterec;B. Sumpio;G. Meier
脾切除术和脾栓塞术已被认为是静脉曲张出血的决定性治疗方法。虽然脾肿大通常与门静脉高压症有关，但门静脉压力和脾肿大之间的血流动力学联系尚不明确。为了阐明脾肿大在门脉高压症患者中的血流动力学意义，回顾性分析了脾大小与门脉压力之间的关系，并前瞻性研究了脾流入对门脉高压的贡献。在50例连续的经血管造影研究的静脉曲张出血患者中，脾脏大小与校正的窦压之间没有相关性。然后前瞻性测量了12名接受远端脾肾分流术的肝硬化患者在脾静脉夹闭前后的门静脉压力。脾静脉血流消失后，无明显压降。基于这些数据，单纯的脾切除术或脾栓塞术在静脉曲张出血的非选择性治疗中似乎没有坚实的血流动力学基础。
Splenectomy and splenic embolization have been advocated as definitive therapy in cirrhotic patients bleeding from varices. While splenomegaly is commonly associated with portal hypertension, no clear hemodynamic link between portal pressure and splenic enlargement has yet been established. In an effort to clarify the hemodynamic significance of splenomegaly in portal hypertensive patients the relationship between spleen size and portal pressure was retrospectively reviewed and the contribution of splenic inflow to portal hypertension prospectively studied. In 50 consecutive cirrhotic variceal bleeders studied angiographically, there was no correlation between spleen size and corrected sinusoidal pressure. Portal pressure was then prospectively measured before and after splenic vein clamping in 12 cirrhotic patients undergoing distal splenorenal shunt. No significant pressure drop occurred following elimination of splenic venous flow. On the basis of these data, there would appear to be no firm hemodynamic basis for splenectomy or splenic embolization alone in the unselective management of cirrhotic patients with variceal bleeding.