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Twenty-second unit of portal hypertension
1. Portal blood flow impeded, the occurrence of stasis, the increased pressure caused by portal system. Clinical manifestations of splenomegaly and splenic hypersplenism, esophageal varices and hematemesis, ascites. The disease with these symptoms is called "portal hypertension." The main cause of portal hypertension due to cirrhosis.
2. Portal hypertension can be divided into prehepatic type, and liver after intrahepatic type categories. Intrahepatic in the most common, accounting for more than 95%.
Second, the anatomy and pathophysiology
(A) of the portal vein by the superior mesenteric vein and splenic vein confluence made. Splenic vein, portal vein blood flow accounts for about 20%. Hepatic portal vein in the action for the left and right two, respectively to the left and right liver, and gradually branch, the small branches and small branches of hepatic artery blood flow within the confluence of the hepatic lobule sinusoidal (liver capillary network) , and then into the hepatic lobule of the central vein, hepatic vein and then into the inferior vena cava.
(B) of the portal vein of the normal pressure of about 1.27 ~ 2.3kPa (13 ~ 24cmH2O). Clinical portal hypertension seen in the patients with portal pressure more in the 2.94 ~ 4.90kPa (30 ~ 50cmH2O) between. Portal hypertension judge can not rely on the determination of the pressure, depend on whether there is portal hypertension related symptoms.
(C) when the portal venous system, cirrhosis of the liver the main pathway of collateral circulation
Portal vein and vena cava between the Department of Transportation supported the following four:
1. Fundus, lower esophageal transport support
Portal blood flow through the gastric coronary vein and short gastric vein, through the esophageal and gastric vein and azygos vein, a branch of half-azygos vein anastomosis, into the superior vena cava. Is the portal vein and vena cava communicating branch between the clinically most important traffic road.
2. Lower Rectum, anal canal communicating branch
Portal blood flow through the inferior mesenteric vein, rectal vein rectal vein, anal vein anastomosis, into the inferior vena cava.
3. Communicating branch anterior abdominal wall
Portal blood flow through the umbilical vein and the ventral side on the deep veins, belly deep venous anastomosis, respectively, into the inferior vena cava.
4. Retroperitoneal communicating branch
After the peritoneum, there are many superior mesenteric, vein branch and another branch of the inferior vena cava anastomosis.
In support of these four traffic, the most important is the fundus, lower esophageal transport expenses. The traffic branch is very small under normal conditions, very little blood flow.
1. An abdominal varicose vein patients, umbilical blood flow in the direction of the bottom above, umbilical blood flow in the following top to bottom. Patients sho
A. superior vena cava obstruction
B. inferior vena cava obstruction
C. portal hypertension or portal vein obstruction
D. iliac vein occlusion
E. iliac vein occlusion
Portal hypertension, with umbilical vein advancing slowly, resulting in portal vein blood by the thoracic wall, abdominal wall superficial veins back to the vena cava. How to determine the direction of blood flow means just mention: refers to the vein flatteners with both hands, release of a hand, if the venous blood flow in rapidly filling the proof -
[Zhenti] 4. Portal hypertension is mainly due î€„
A. Congenital portal vein î€„
B. Hepatic vein thrombosis, stenosis î€„
C. Hepatic inferior vena cava obstruction î€„
D. Cirrhosis î€„
E. Splenic vein blood flow caused by various reasons, excessive î€„
Answer: D î€„
Analysis: liver cirrhosis and regeneration of fibrous hyperplasia of the liver sinusoidal cell nodule squeeze, making it narrower or occlusion, leading to portal vein obstruction, portal vein pressure increased.
ZLã€‘ ã€6 î€ portal vein and vena cava in the traffic branch, the most important is the A î€„
A î€ gastric, lower esophageal transport support î€„
B î€ lower rectum, anal canal communicating branch î€„
C î€ î€„ communicating branch anterior abdominal wall
D î€ communicating branch î€„ retroperitoneal
E î€ î€„ communicating branch of liver capsule
ZLã€‘ ã€8. Belonging to the following portal venous system is C
A. Iliac vein
B. Renal vein
C. Splenic vein
D. Hepatic vein
E. Rectal vein
Portal vein branches of a simple diagram: six quarters, representing the five major tributaries:
Concord Problem 8. Portal hypertension is the main reason
A portal vein thrombosis
B hepatic vein occlusion
D portal vein thrombosis in
E polycystic liver
8. Answer; C
Concord Problem 6. Portal vein and vena cava communicating branch between the most clinically significant is
A gastric, lower esophageal transport support
B lower rectum, anal canal communicating branch
C communicating branch of abdominal wall
Communicating branch retroperitoneal D
E None of the above
6. Answer; A
(D) the major portal hypertension complications
1. Splenomegaly and hypersplenism
Portal vein obstruction, congestive enlargement of the spleen first appears. Long-term splenic sinus congestion, fibrous tissue proliferation occurred in spleen and marrow cells in regeneration of the spleen, the spleen caused by increased destruction of blood cell function.
2. Communicating branch expansion
Lower esophageal and gastric varicose veins occur, the vulnerability to food or stomach acid reflux rough corrosion of the injury; particularly nausea, vomiting, coughing, sudden weight increase of portal pressure and other circumstances, varices, acute massive bleeding . Rectum, the venous plexus can cause secondary expansion of hemorrhoids; umbilical vein and abdominal side, down the expansion of deep vein communicating branch varicose veins can cause the anterior abdominal wall; small retroperitoneal veins are dilated congestive.
[Zhenti] 3. Cirrhosis and portal hypertension is the most diagnostic value of the performance î€„
A. Ascites î€„
B. Splenomegaly, hypersplenism î€„
C. Abdominal varicose vein î€„
D. Esophageal, gastric varices î€„
E. Jaundice î€„
Answer: D î€„
Analysis: esophageal, gastric varices and portal hypertension by the impact of the earliest and most significant, and the most unique.
[Zhenti] 6. Patients with liver cirrhosis best describes the performance of existing portal hypertension is î€„
A. Ascites î€„
B. Widened portal vein î€„
C. Splenomegaly î€„
D. The formation of hemorrhoids î€„
E. esophageal varices î€„
Answer: E î€„
Analysis: Four communicating branch to the first occurrence of esophageal varices, the most significant.
ZLã€‘ ã€1. Portal hypertension is the most dangerous complications î€„ E
A. hepatic encephalopathy î€„
B. thrombocytopenia î€„
C. î€„ refractory ascites
î€„ congestive splenomegaly D.
E. esophageal and gastric variceal bleeding î€„
Mainly due to cirrhosis of liver dysfunction, which impeded the synthesis of albumin, content reduced, the plasma colloid osmotic pressure decreases. In addition, liver insufficiency, adrenal cortex aldosterone and antidiuretic hormone neurohypophysis inactivated by the liver increased less than in the body, promoting Shen Xiaoguan of sodium and water re-absorption, and cause sodium and water retention. In addition, portal pressure increased, so that the filtration of portal vein pressure increases capillary bed, increasing the capacity of the liver lymph, poor return, resulting in a large number of lymph from the liver surface leakage into the abdominal cavity.
ZLã€‘ ã€2. The following is the performance of portal hypertension is î€„ C
A. liver palms
Concord Problem 16. Male, 42 years old, suddenly a lot of vomiting, abdominal pain, no previous history. Temperature 37 â„ƒ, pulse 98 beats / min, blood pressure 100/80 mmHg, scleral jaundice and liver not palpable, spleen, large quarter ribs 3cm, hard, knocking out the move is not voiced, red blood cells 2.24 Ã— 1012 / L, Hb : 72g / L, since the cells 9 Ã— 109 / L, platelets 80 Ã— 109 / L, may be diagnosed as
A gastric ulcer disease
E portal hypertension
l6. Answer; E
Third, the treatment of portal hypertension
(A) of the two types of surgery
1 Department of bypass surgery and the cavity is about portal venous system connected together, the higher the pressure the blood portal system directly to the vena cava to shunt.
2, the drying operation that splenectomy, while surgical portal azygous block abnormal blood between the sulfur, in order to achieve the purpose of hemostasis.
1, bypass surgery
â‘ shunt -1
Splenorenal shunt surgery: After splenectomy, the splenic vein stump and the left renal vein on the side for the match;
â‘¡ shunt -2
Portacaval shunt, including bypass graft portacaval shunt: the portal vein directly to the inferior vena cava end to side to side to side or bridge or "H" type anastomosis; points larger flow, not a lot of blood filtration by the liver into the brain, complicated by hepatic encephalopathy.
â‘¢ shunt -3
Spleen and vena cava shunt: After splenectomy, the splenic vein stump and inferior vena cava for anastomosis on the side;
â‘£ shunt -4
Superior mesenteric, inferior vena cava shunt: the bifurcation of common iliac vein and inferior vena cava above the anastomosis to the superior mesenteric vein stump side. It was also the inferior vena cava with the superior mesenteric vein directly side to side anastomosis, or with autologous vein (cut Yiduan right jugular vein) graft, anastomosed to the inferior vena cava and the superior mesenteric vein, and that means the so-called "bridge" or "H" anastomosis.
â‘¤ The jugular vein intrahepatic portosystemic shunt (TIPSS), is the use of interventional radiology approach, the puncture of internal jugular vein catheter inserted through the right hepatic vein, liver parenchyma in the right branch of portal vein puncture or left branch, the establishment of door channel After the placement of about 6cm long or support blood vessels dilated and prevent retraction of the liver tissue to maintain patency of intrahepatic portal systemic shunt; shunt diameter generally up to 8 ~ 10mm.
(B) the pros and cons of bypass surgery
(1) the high pressure portal vein into the inferior vena cava blood flow, significantly reducing the pressure of the portal vein system, the fundus, an effective drainage of esophageal varices, the prevention and treatment of recurrent bleeding effect is positive.
(2) lost some of the liver portal vein perfusion, intestinal absorption of toxic metabolites to bypass the liver to increase the incidence of postoperative encephalopathy.
Concord Problem 3. Portal hypertension shunt, portal vein pressure decreased most significantly, while the incidence of hepatic encephalopathy is the highest surgical
A splenorenal shunt
B portacaval shunt
C spleen vena cava shunt
D superior mesenteric, inferior vena cava shunt
E inferior vena cava and the superior mesenteric vein between the "bridge" anastomosis
3. Answer; B
Concord Problem 4. Patients with portal hypertension, the implementation of bypass, which one is correct
A significant jaundice patients
B serum albumin less than 50g / L should not be carried out when
C for esophageal variceal bleeding in patients
D for patients with severe ascites
E will not occur after gastric, esophageal varices
4. Answer; C
For no jaundice, no obvious ascites, liver function I, II-class patients.
2, the drying operation
Including esophageal transection and gastric transection, resection of esophageal and gastric cardia breaking of peripheral vascular surgery and so on. Which the breaking of pericardial blood vessel surgery is most effective.
(C) pericardial blood can be divided into 4 groups:
(1) coronary vein: including gastric branch, esophagus, and esophageal branch support. Smaller stomach sticks, walking along the lesser curvature of the stomach, accompanied with the right gastric artery. Esophageal branches coarse, accompanying the left gastric artery, splenic vein in the retroperitoneal injection; the other end of the branch in the cardia and stomach, below the confluence and into the gastric and esophageal. Support from the coronary vein esophageal esophageal branches of the Ministry raised from the right side of the 3 ~ 4cm at the cardia, along the lower esophageal walk up the right rear, in the cardia or higher above the 3 ~ 4cm enters the esophagus muscular layer. Proposed special needs, and sometimes a "ectopic esophageal sticks", which exist with esophageal branch, originated in the coronary vein, may also be originated in the portal vein, the right side farther away from the cardia, 5cm or more in the cardia muscle was higher up into the esophagus;
(2) short gastric vein: usually 3 to 4, accompanied with the short gastric arteries, located in gastric fundus of the anterior and posterior wall, into the splenic vein;
(3) gastric vein: Starting in gastric wall, accompanied by the same name descending artery, into the splenic vein;
(4) the left inferior phrenic vein: can be single or branch into the left gastric or lower esophageal muscle.
[Zhenti] 7. Pericardial vascular surgery to be amputated from the broken blood vessels are not included in î€„ (2004)
A. Gastric coronary vein î€„
B. Short gastric vein î€„
C. Right gastroepiploic vein î€„
D. Gastric vein î€„
E. Left subphrenic vein î€„
Answer: C î€„ (2004)
Analysis: pericardial blood does not include the right gastroepiploic vein î€„.
(D) peripheral vascular cardiac surgery has its breaking away from the more reasonable of the Department:
â‘ from broken blood vessels around the cardia, the portal pressure is not reduced, but also increased the; is even more because of the increased portal pressure, ensuring the increase in hepatic portal blood flow, thus contributing to the regeneration of liver cells and improve its function.
â‘¡ breaking of pericardial vascular surgery for stomach and spleen in a particular operation left gastric venous hypertension, the purpose is strong, immediate and precise hemostasis.
(E) breaking of pericardial vascular surgery, in addition to precise control of esophageal and gastric variceal bleeding, and maintained portal perfusion of the liver, the less damage due to surgery, a small burden on patients, surgical mortality rates are more low. Also, because the operation more simple and easy to promote grass-roots units.
ZLã€‘ ã€7 î€ women, 5l-year-old, hepatitis B more than 30 years history. 2 hours before the sudden appearance of vomiting after eating biscuits, about 800 ml, examination: skin, mucosa stained yellow body, no ascites, and if emergency surgery, the best surgical approach is î€„ D
A î€ transjugular intrahepatic portosystemic shunt î€„
B î€ nonselective portosystemic shunts î€„
C î€ selective portal shunts î€„
D î€ breaking of pericardial vascular surgery î€„
E î€ splenectomy î€„
Concord Problem 12. Men. 43 years old, occurred before 2 months of upper gastrointestinal bleeding. Confirmed by endoscopy of esophageal varices, previous history of hepatitis B, the current mild liver damage, which surgical procedures should be selected, both the prevention of esophageal variceal rebleeding, but also the least impact on liver function
A splenorenal shunt
B about vena cava superior mesenteric vein shunt
Portacaval shunt C
E splenectomy, surgery pericardial blood vessel breaking
l2. Answer; E
(F) Evaluation devascularization
A variety of devascularization, splenectomy in addition to itself may be due to splenic vein reflux reduces portal pressure lowering benefit on the outside, is by blocking the portal vein system and gastric, esophageal varices link between the abnormal blood flow, reducing varicose vein treatment and prevention of pressure to bleeding. This can lead to increased pressure portal venous system, varicose veins and the pressure difference between the more extended and re-formation of collateral pathways, and thus higher rate of recurrent bleeding after surgery. And the drying operation, the portal vein pressure increased, easy-to-portal vein caused by stasis, postoperative ascites and gastric hyperemia, edema and other diseases and even gastric bleeding rates. As for the pure schistosomiasis cirrhosis and portal hypertension caused by bleeding, surgical splenectomy has certainly added therapeutic value of disconnection, to take precedence. The fundamental reason is that such patients are more good liver reserve function, and liver cirrhosis are essentially different.
[Zhenti] 1. Portal hypertension is the main purpose of surgery î€„
A. Treatment of ascites î€„
B. Improving liver function î€„
C. Prevention and control of esophageal and gastric varices bleeding î€„
D. î€„ treatment of hepatic encephalopathy
E. Removal of the cause of portal hypertension î€„
Answer: C î€„
Analysis: portal hypertension, mainly through surgery to treat shunt and devascularization esophageal and gastric varices.
[Zhenti] 2. Portal hypertension for elective surgery î€„ The main objective is to
A. Increase resistance î€„
B. Prevention of liver failure î€„
C. î€„ prevent liver cancer
D. Prevention of upper gastrointestinal bleeding î€„
E. Reduce ascites î€„
Answer: D î€„
Analysis: elective surgical treatment of esophageal and gastric varices, prevention of esophageal and gastric variceal bleeding caused.
[Zhenti] 8. Surgical treatment of portal hypertension is the main purpose of î€„
A. î€„ lifting hypersplenism
B. Elimination of ascites î€„
C. î€„ prevention of upper gastrointestinal bleeding
D. Improving liver function î€„
E. Prevention and treatment of hepatic coma î€„
Analysis: The disconnection and shunt surgery, reducing the extent of varicose veins in order to achieve the prevention of esophageal and gastric variceal bleeding caused purpose.
[Zhenti] 5. The treatment of portal hypertension, the error is î€„
A. Inferior vena cava and portal vein anastomosis could easily lead to hepatic encephalopathy î€„
B. Bleeding esophageal varices non-surgical treatment of choice for three-cavity tube hemostasis î€„
C. Endoscopic esophageal varicose veins in blue need emergency surgery î€„
D. When possible esophageal varices Endoscopic injection sclerotherapy of esophageal î€„
E. Intravenous infusion of vasopressin can reduce the portal pressure î€„
Answer: C î€„
Analysis: bleeding esophageal varices but do not need emergency surgery.
ZLã€‘ ã€3. Surgical treatment of portal hypertension the main purpose of î€„ D
A. reduce hepatic encephalopathy î€„
B. correcting thrombocytopenia î€„
C. Prevention of ascites complicated by infection î€„
D. Control of esophageal and gastric variceal bleeding î€„
E. Treatment of refractory ascites î€„
ZLã€‘ ã€4. Surgical treatment of portal hypertension î€„ A main purpose of
A. stop bleeding or prevent bleeding î€„
B. Elimination of ascites î€„
C. Elimination of hypersplenism î€„
D. î€„ eradication of liver damage
E. Improve digestion î€„
Shared casual working (25 ~ 27 items)
Women. 27. Sudden vomiting to the emergency room vomiting 2 times, about 1200ml, blood red, the patient denied previous history of hepatitis
Concord Problem 25. Physical examination and portal hypertension is consistent signs
A spleen ribs no time
B blood pressure ll/8kPa
C varicose veins on the abdominal wall
D, abdominal tenderness
E suspicious stained yellow sclera
25. Answer; C
Concord Problem 26. To clarify the cause of bleeding, the patient vital signs stabilized. What checks should be selected
A selective angiography of abdominal aorta
B, abdominal gastrointestinal barium radiography
C B-type ultrasonic examination of liver, spleen
D fiber gastroscopy
E-cavity tube with three clear reasons for bleeding
26. Answer; D
Concord Problem 27. Check the clear after a series of patients with cirrhosis, esophageal varices, splenomegaly, no jaundice, the patient if the surgical treatment, surgery should not be which of the following lines
A splenectomy, splenorenal shunt
B splenectomy, portacaval shunt restrictive
C splenectomy, surgery pericardial blood vessel breaking
D splenectomy, splenic shunt
E splenectomy alone
27. Answer; E
A spleen, kidney shunt
B portacaval shunt
C superior mesenteric vein, inferior vena cava shunt did not bridge
D superior mesenteric vein, inferior vena cava shunt side
E remote spleen, kidney shunt
Concord Problem 28. Reduce portal pressure have a greater role for the surgical
28. Answer; B
Concord Problem 29. Selective shunt for the
29. Answer; E
Concord Problem 30. The incidence of postoperative hepatic encephalopathy is the highest shunt
30. Answer; B
2. Complication judge -2
3. Surgical operation in particular purpose -3
World Vision found that dark chocolate can help treat liver cirrhosis http://www.cnnb.com.cn China Ningbo Net 10 at 15:28 on April 16 concerned people, love life, Ningbo, China Network Information Hotline: 13777110707
Xinhua Beijing April 16 15, Reuters Spanish scientists say dark chocolate can effectively relieve patients with cirrhosis and portal hypertension, dark chocolate or a prescription to be included in patients with cirrhosis.
The blood circulation of the liver by the hepatic artery and portal vein complete, portal hypertension is cirrhosis of the liver caused mainly by a common disease, its symptoms such as splenomegaly and ascites.
Previous studies showed that eating dark chocolate and other foods rich in cocoa can reduce blood pressure.
Spanish researchers 15 in Vienna, Austria, the annual meeting of the European Association for Study of the Liver published reports that dark chocolate contains a lot of cocoa flavanols, the composition is conducive to maintaining blood vessel elasticity, which help stabilize blood pressure.
Patients with advanced cirrhosis of the liver in the postprandial portal vein blood pressure is usually increased. The researchers gave 21 patients with advanced cirrhosis of the liver to eat while taking in up to 85% cocoa content dark chocolate and found that the rate of patients with portal hypertension greatly reduced.
Imperial College London Mark Withers liver specialist, said the survey showed that eating dark chocolate and mitigation portal hypertension clear link between dark chocolate or a prescription to be included in patients with cirrhosis. Manuscript Source: Xinhua Editor: Xu Ting you civilized, rational statements and comply with relevant provisions of the comments only after registration, Ningbo, China Network Registered users can post comments . enter the answer: [I want to Tougao | enter forum | distributed friend | Print this page | Back | Close Window]
Wang Xiuyan, ultrasound treatment center in Shandong Provincial Hospital, Clinical Medical College, Shandong University, Jinan, Shandong 250021, China
You Xiao Gong, Tai'an City, Tai'an City, Shandong Province 271000 Medical School
Shibao Min, Mu Qingling, Wutai Huang, General Surgery, Shandong Provincial Hospital, Jinan, Shandong Province 250021, China
Youth Foundation of Shandong Province medical and health issues, No.1999CA2BJBA1
Person in charge: Wang Xiuyan, 250021, Shandong Province, Jinan City Rd 324, ultrasound treatment center in Shandong Provincial Hospital, Shandong University, School of Clinical Medicine. Wangxiuy87@yahoo.com
Tel :0531 -7938911-2530 Fax :0531 -7,937,741
Received date :2002-11-29 Accepted :2002-12-26
Objective: To study the splenic volume, splenic vein blood flow and peripheral blood cell counts with different grades of liver function, which reveals them to the clinical stage of portal hypertension in significance.
Methods: Color Doppler ultrasound measured in 40 patients with cirrhosis and portal hypertension in patients with spleen size, splenic vein and portal vein blood flow velocity and blood vessel diameter, and the Child classification of peripheral blood cell counts and to study the correlation between the indicators and between different liver function difference.
Results: The splenic vein, splenic vein blood flow velocity, portal vein blood flow velocity and peripheral WBC count in the Child classification of the differences among the three groups was significant, while the portal vein, peripheral RBC, PLT count between the three groups There was no significant difference. splenic vein and splenic vein blood flow velocity was negatively correlated (r =- 0.43), and portal vein velocity was also negatively correlated (r =- 0.330). WBC and splenic vein flow was positively correlated (r = 0.353 ), and portal vein blood flow velocity was positively correlated (r = 0.393). splenic volume and the HB was a negative correlation (r =- 0.620), and PLT was negatively correlated (r =- 0.8.34). PLT was positively correlated with the HB (r = 0.583).
Conclusion: Child classification and the degree of hypersplenism reflected in the indicators no significant correlation of peripheral blood cell counts; stages of portal hypertension and liver function should refer to both the spleen function.
Wang Xiuyan, Yu Xiao Gong, Shibao Min, Mu Qingling, Wutai Huang. Splenic volume, splenic vein blood flow and blood cell counts in the staging of portal hypertension significance. World Journal of Gastroenterology 2003; 11 (6) :861-862
0 Introduction With the growing liver fibrosis, eventually leading to portal hypertension and liver decompensation. One important change is the pathophysiology of splenomegaly with hypersplenism, to a certain extent, affect the progress of the disease and prognosis [1,2]. of splenic volume, splenic vein, portal vein blood flow and blood count and hemodynamic indicators in different grades of liver function, which can establish the spleen to determine the changes in the progression of portal hypertension and Staging important role.
1 Materials and methods
1.1 Materials Danish production BK3535 color Doppler ultrasonography, the frequency 3.5HZ. Experimental group was clinically and pathologically confirmed through post-hepatitis patients with cirrhosis and portal hypertension 40 (47 cases were collected during 1997-7/1999-12 , 40 patients met the criteria), 31 males and 9 females. The average age of 45 years (18-65 years). the control group for the same period in healthy subjects received 20 patients, no liver, heart, kidney disease history, liver function properly. sex and age between the two groups was no significant difference. Child classification modified Child-Pugh grading.
1.2 Methods fasting patients 8h, supine position, quiet breathing. Specified conditions, the same person operation, the prior determination of liver function in patients with the situation I do not know. Sampling location in the portal vein from the left branch of portal vein at 1-2cm, splenic vein in splenic hilum 2cm. sampling volume close to the vessel diameter is better, the sound beam angle and direction of blood flow control in 60. or less. Repeated for each sampling location to determine the typical vein Doppler spectrum appears, at which point breath-hold, Take a cardiac cycle, measurements of mean blood flow velocity. The results calculated as follows: blood flow = mean flow velocity Ã— vessel cross-sectional area. OUTCOME MEASURES: The mean flow velocity, vessel diameter, blood flow. splenic maximum diameter of the spleen was measured, horizontal diameter and thickness, the product of three multiplied by 0.6, as the spleen volume estimates. of splenic volume, splenic vein diameter and flow rate, blood count, portal vein velocity, portal vein diameter in different liver function of Child-Pugh classification and the difference between the degree of correlation among the indexes.
SPSS10.0 statistical package using statistical methods, ANOVA and correlation analysis to calculate the difference between the measured values. P 2 results among the different Child classification, only the splenic vein, splenic vein blood flow velocity, portal vein WBC counts in peripheral blood flow velocity and the difference between the three groups was significant, with the deepening of Child grade, the gradual increase in splenic vein, splenic vein blood flow velocity, portal vein blood flow velocity and peripheral blood WBC count gradually smaller ; the portal vein, peripheral RBC, PLT count differences between the three groups were not significantly (Table 1). splenic vein diameter and
Table 1 Child classification of each index between the results of ANOVA F value P value targets inside diameter of splenic vein splenic vein flow velocity 4.8730.013 4.8320.014 splenic volume 4.1360.024 0.6560.525 portal vein portal vein velocity of 16.193 WBC5.2860.010 HB1 .7460.189 PLT1.9350.159
Splenic vein blood flow velocity showed a negative correlation, r =- 0.43, P3 discussion portal hypertension portal vein hemodynamics have been a more systematic study of color Doppler ultrasound has become the judge to evaluate the efficacy of its course and the most common methods. different classification and different surgical treatment Child portal vein blood flow velocity and the Department of changes in blood flow, has basically reached a consensus. but on the size of the spleen, peripheral blood cell counts, splenic vein and portal vein blood flow velocity and flow in different Child classification changed little research, the correlation between them has not been clarified in greater detail.
3.1 Child grading and classification of splenomegaly and hypersplenism with liver cirrhosis and portal hypertension is an important feature of an incidence of between approximately 6-92% . Splenomegaly hypersplenism caused a major consequence blood cell lines or three lines a single reduction, with or without bone marrow hyperplasia. This increased pool of blood and spleen, strengthen the role of filtering the blood and body fluids of many factors related to changes in . This set of data confirms that portal hypertension , spleen size and peripheral HB, PLT was negatively related to the greater volume of the spleen, peripheral blood PLT HB and less, indicating that the spleen volume is important to determine indicators of hypersplenism one. but the peripheral WBC was not associated with them , does not match the results of previous studies , the difference may be related to patient selection.
The study also confirmed that although the spleen size in different Child classification under the difference was significant, but with the portal vein and splenic vein, portal vein and splenic vein blood flow velocity was no significant correlation, suggesting that portal hypertension when the splenic volume increased not be the only portal vein and the hemodynamic changes related to the body may be related to the proliferation of the reticuloendothelial system, spleen and other reasons have more to fibrosis . Piscaglia splenomegaly compared 124 patients with liver cirrhosis and 39 patients with hematologic disease caused by splenomegaly, the results show that splenic artery resistance index and portal vein blood flow velocity between the two groups was significant difference. portal hypertension in patients with splenic artery resistance index increased, while the portal vein blood flow velocity was reduced . Bolognesi reported after liver transplantation in cirrhotic patients during the immediate increase in portal blood flow, 2a back to normal after; and splenomegaly there has been follow-up to the 4a, and portal venous flow is relevant . through the liver biopsy of their the fibrosis grade, can be divided into four, XU Hong-wei et al  found that the higher the degree of liver fibrosis, spleen size larger three lines were reduced in peripheral blood. is also shown that the degree of hypersplenism splenic volume can be , to reflect changes in peripheral blood cells.
On the other hand, the most commonly used to determine the process of portal hypertension in Child grading system, and can not fully reflect its characteristics. The degree of hypersplenism. So evaluation of portal hypertension clinical stage, the system is not enough simply relying on Child The. China has put forward its own in 1984, staging of liver function, but does not refer to their own portal hypertension stage, so it is not included in the indicators of hypersplenism .
The group results also show that under different Child classification, portal vein, peripheral RBC, PLT count between the three groups were not significantly different. That fibrosis in the liver and portal vein, hepatic dysfunction in the process of there is no characteristic changes, not as one of the basis of its clinical stage. is consistent with other studies . reflect the degree of peripheral blood hypersplenism HB, PLT Child in a different classification was no significant difference in the nature Child classification and proved once again that the degree of hypersplenism was no significant correlation.
3.2 Clinical staging of portal hypertension and portal hypertension related to systemic hemodynamics and multiple organ function changes, its more accurate and comprehensive clinical stage is more difficult. Traditionally, according to Warren staging to take a different approach the determination of total blood flow, liver blood flow and portal blood flow, the portal hypertension hemodynamics stage, but did not consider the case of hypersplenism. In fact, the spleen in patients with portal hypertension occurs Many vascular histology, physiology, immunology and other aspects of change, splenomegaly is not only portal hypertension in the result, but also an important contributing factor . Moreover, portal hypertension surgery for the primary purpose is to reduce portal pressure prevention and treatment of esophageal variceal bleeding and correct splenomegaly, hypersplenism, so if its more accurate clinical staging, liver function and should take care of both the spleen function. and reflect the degree of hypersplenism splenic volume and peripheral blood cell counts, should be the clinical stage of portal hypertension in the light of the important indicators.
4 References 1 Macias-Rodriguez MA, Rendon-Unceta P, Martinez-SierraMC, Teyssiere-Blas I, Diaz-Garcia F, Martin-Herrera L.
Prognostic usefulness of ultrasonographicsigns of portal hypertension in patients with child-pugh stage Aliver
cirrhosis. Am J Gastroenterol 1999; 94:3595-3600
2 Mutchnick MG, Lerner E, Conn HO. Effect of portacaval anastomosison hypersplenism. Dig Dis Sci 1980; 25:929-936
3 Shah SH, Hayes PC, Allan PL, Nicoll J, Finlayson ND. Measurement ofspleen size and its relation to hypersplenism
and portal hemodynamics in portalhypertension due to hepatic cirrhosis. Am J Gastroenterol 1996; 91:2580-258
4 Bolognesi M, Merkel C, Sacerdoti D, Nava V, Gatta A. Role of spleenenlargement in cirrhosis with portal hypertension.
Dig Liver Dis 2002; 34:144-150
5 Bolognesi M, Sacerdoti D, Bombonato G, Merkel C, Sartori G, MerendaR, Nava V, Angeli P, Feltracco P, Gatta A.
Change in portal flow after livertransplantation: effect on hepatic arterial resistance indices and role ofspleen
size. Hepatology 2002; 35:601-608
6 Xie Dongying, Xieshi Bin, Li Yongzhong, YAO Chun-lan, Lu Yao set. Hepatic fibrosis and portal vein, splenic vein diameter, spleen size and the relationship between blood cell counts. Chinese Journal of Digestive
Journal 2000; 20:308-310
7 XU Hong-wei, ZHU Ju, Sun Chenggang, Wan Zhao Hai, Lu Weijun. Cirrhotic patients with portal hemodynamics of clinical value. Journal of Liver Diseases 2000; 8:55
8 Shibao Min, Yang Zhen. Splenic portal hypertension in patients with vascular disease and its pathogenesis. Chinese Medical Journal 2000; 80:196-198