ALTERATIONS IN THORACIC DUCT LYMPH FLOW IN HEPATIC CIRRHOSIS - SIGNIFICANCE IN PORTAL HYPERTENSION
ALTERATIONS IN THORACIC DUCT LYMPH FLOW IN HEPATIC CIRRHOSIS - SIGNIFICANCE IN PORTAL HYPERTENSION
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DOI：
10.1097/00000658-196210000-00013
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发表时间：
1962-01-01
影响因子：
9
通讯作者：
MULHOLLAND, JH
中科院分区：
文献类型：
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作者：
DUMONT, AE;MULHOLLAND, JH
Laennec‘s肝硬变患者在开腹手术中经常会遇到LYMP从肝包膜和肝门处肿胀的淋巴管中渗出。肝脏淋巴流量的这种重要改变，尽管起源不明，但明显地启动了腹水的形成。肝硬变中另一个突出的紊乱，门静脉压力升高的来源也不清楚，因为这种压力与食道静脉曲张出血之间的关系的本质也是未知的。认为门静脉高压是由单纯性门静脉阻塞引起的，忽略了这样一个事实，即这种血流动力学效应是不寻常的，不能在实验上复制。**Starling指出，静脉阻塞不会导致持续性静脉高压。**水肿、淋巴流量增加和侧支静脉流量增加可以消除压力，防止任何显著的永久性增加。在上纵隔综合征和缩窄性心包炎的特殊情况下，持续性静脉高压与消散失败有关，因为淋巴形成如此之多，以至于流过
LYMP LEAKING from clusters of bulging lymphatics on the liver capsule and at the porta hepatis often is encountered at laparotomy in patients with Laennec's cirrhosis. This important alteration in hepatic lymph flow, however obscure in origin, apparently initiates ascitic fluid formation. Origin of the other prominent derangement in cirrhosis, elevated portal vein pressure, also is obscure, as is the nature of the relation-ship between this pressure and bleeding from esophageal varices. To consider that portal hypertension is due to simple portal vein obstruction is to disregard the fact that such hemodynamic effect would be unusual and incapable of experimental duplication.** Starling pointed out that venous obstruction does not result in sus-tained venous hypertension.** Edema, increased lymph flow and collateral venous flow dissipate the pressure and prevent any significant permanent increase. In the special instance of superior mediastinal syndrome and in constrictive pericarditis sustained venous hypertension is related to failure of dissipation in that lymph formation is so increased that flow through over