門脈圧亢進症における門脈循環の特性と食道静脈瘤の成因に関する考察

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  • Charactaristics of splanchnic portal circulation in portal hypertension as analysed by pressure study in clinical cases.
  • モンミャクアツ コウシンショウ ニ オケル モンミャク ジュンカン ノ トクセ

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Intraoperative pressure study was made in patients with portal hypertension in order to examine discreteness of splanchnic portal area from portal trunk. Twenty-seven patients with portal hypertension including 21 cirrhosis of the liver and 6 idiopathic portal hypertension and 10 controls were subjected. In each case left gastric vein was ligated as near the junction of portal vein as possible, and catheters were introduced into proximal left gastric vein as well as portal vein for simultaneous pressure measurement. Relationship between occluded left gastric vein pressure (OLGP) and portal vein pressure was simultaneously recorded under with and without portal clamping. <BR>In control group, OLGP, which was almost the same value to the free portal vein pressure, was found to have followed to the increasing portal pressure, when the portal vein was clamped. In portal hypertension group under portal vein clamping, however, OLGP elevated a little, but did not attain to the height of portal clamp pressure. The difference between the two groups was statistically significant. Quantitative analysis using simulation model for portal circulation suggested that flow resistance between the left gastric artery to the vein in portal hypertension group markedly decreased down to about one-twentieth of the control group, leading remarkable increase of arterial inflow into the portal area. <BR>Although the study is remained awaited why the increase of arterial inflow takes place in portal hypertension patients, incontinence of the arterio-venous shunt is possible. This postulation is considered to play major role in formation of esophageal varices.

収録刊行物

  • 肝臓

    肝臓 18 (12), 891-898, 1977

    一般社団法人　日本肝臓学会

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