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目的 :观察肝癌不同治疗方法对门静脉压力 (FPP )的影响 ,并探讨 FPP变化与肝癌术后早期上消化道出血之间的联系。方法 :10 8例肝癌患者 ,分别行肝切除 (n=74)、肝动脉栓塞化疗 (n=11)、肝动脉结扎 (n=3)、肝动脉门静脉插管 (n=14)、肿瘤内无水酒精注射 (n=6 )及术后肝动脉门静脉化疗 (n=2 2 ) ,术中经胃网膜右静脉插管至门静脉主干 ,并将埋植式给药装置 (IDDS)植于腹壁皮下 ,经 IDDS分别测量治疗前、治疗后及术后 1、3、5、7、14、2 1、2 8天之 FPP。结果 :除肝动脉门静脉插管及肿瘤内无水酒精注射外 ,其余各种治疗方法术后 FPP均出现一过性升高 ,以术后 1～ 7天升高最为显著 ,之后逐渐缓慢下降 ;2 4例 FPP≥35 cm H2 O者 ,16例并发术后早期上消化道出血 ,而 FPP<35 cm H2 O的全部病例均未发生出血。结论 :肝切除、肝动脉栓塞化疗等主要治疗方法将造成 FPP升高 ,FPP的升高与术后早期上消化道出血之间存在密切联系 ,动态监测 FPP变化有助于上消化道出血的防治
Objective: To observe the effect of different treatments of liver cancer on portal pressure (FPP), and to explore the relationship between FPP changes and early postoperative upper gastrointestinal hemorrhage. Methods: One hundred and eight patients with liver cancer underwent hepatectomy (n = 74), hepatic arterial chemoembolization (n = 11), hepatic artery ligation (n = 3), hepatic artery and portal vein catheterization Anhydrous alcohol injection (n = 6) and postoperative hepatic artery and portal vein chemotherapy (n = 22) were performed during the operation. The patients were intubated through the right gastric venous catheter to the main vein of the portal vein during operation, and the implantable drug delivery device (IDDS) Subcutaneous abdominal wall, measured by IDDS before treatment, after treatment and after 1,3,5,7,14,2 1,28 days of FPP. Results: Except for hepatic artery and portal vein catheterization and intratumoral injection of alcohol, all the other treatments showed a transient elevation of FPP postoperatively, with the most significant increase from 1 to 7 days after operation, and then gradually decreased. Twenty-four patients with FPP≥35 cm H 2 O had early upper gastrointestinal bleeding after operation, and no bleeding occurred in all patients with FPP <35 cm H 2 O. Conclusion: The main treatment methods such as hepatectomy and hepatic arterial chemoembolization will lead to the increase of FPP. There is a close relationship between the increase of FPP and the early postoperative upper gastrointestinal bleeding. The dynamic monitoring of FPP changes is helpful to the prevention and cure of upper gastrointestinal bleeding