간유입 혈류 차단시 문맥압의 변화
Idiosyncratic Portal Collateral Circulation under the Hepatic Inflow Occlusion
의학과 외과학 전공
혈류차단 문맥압 간유입;
- 원문 URL
(Purpose) Acute ligation of the portal vein in animal results in pooling of blood in splanchnic bed followed by rapid cardiovascular collapse and death. However, human can withstand portal inflow occlusion because of portal collateral circulation. I tried to prove the development of portal collateral circulation in the case of acute portal inflow occlusion by serial measurement of portal pressure. (Methods) 187 patients who underwent liver resection with portal triad clamping (PTC) were studied. We inserted a catheter to right gastroepiploic vein and measured portal pressure before PTC, after PTC and just before reperfusion of the last clamping. (Result) During the liver resection, portal pressure decreased gradually because of collateral circulation development by 61.8 mmH_(2)O in normal liver group, 71.1 mmH_(2)O in chronic hepatitis group, 43.0 mmH_(2)O in cirrhosis group. The differences among three groups has no statistical significance. Moreover, there was no difference in portal pressure decrease between intermittent and continuous clamping group. However, the decrease of portal pressure in 21 patients with varices was much less than those without varices (10 mmH_(2)O vs. 62.7 mmH_(2)O, p=0.008). In recent 20 cases, we additionally measured portal pressure 15 minutes and 30 minutes after PTC. The pressure decreased to nearly full extent within the first 15 minutes after PTC. (Conclusion) Gradual decrease of portal pressure during PTC suggests the development of portal collateral circulation. It makes possible the partients to tolerate liver ischemia during liver resection or transplantation. Most of collateral circulation seems to be developed within the first 15 minutes after PTC.