肝表面動脈枝および門脈枝の出現と供給路である肝動脈および門脈の血行動態変化の臨床的検討

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  • Clinical E valuation of Vascular Pattern of the Hepatic Surface and Circulatory Changes in the Hepatic Artery and Portal Vein.

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In the course of viral chronic hepatic disease, we evaluated the number of arterial branches and portal vein branches on the liver surface obserbed by laparoscopy, and circulatory changes in the hepatic artery and portal vein supplying blood to the liver surface vessels. The subjects consisted of 33 patients who were diagnosed under laparos-copy with viral chronic hepatic disease, and 14 controls without hepatic disease. We classified liver surface appearance with the first digit in the three-digit code number system propoed by Shimada. The number of arteriolar branches obserbed by laparoscopy increased with the advance of the disease. The diameter of the proper hepatic artery measured by angiogram remained either anchanged or increased, and maximum flow rate in the anterior branch of the right hepatic artery, , measured by Doppler's color method, increased with the advance of the disease. These findings suggested that the blood flow velocity and volume increased with the advance of the disease. We injected ICG into the proper hepatic artery and measured onset time, peak time and peak value by by ICG meter. These findings suggested that the blood flow velocity in the hepatic artery and A-V fistulae in the liver increased with the advance of the disease. The number of portal vein branches on the liver surface observed by laparoscopy increased in grade with code numbers as high as a 400-range reading, but slightly decreased in 500-range-lesions. As for the morphological and hemodynamic change of the portal vein, the ratios of the cross-sectional area and flow volume in the right anterior portal branch, as compared to the main portal trunk, were remained unchanged in lesions with readings to as high as 400. However in the 500-range, the flow volume of the right anterior portal branch per cross-sectional area decreased. The number of arterioler branches and portal vein branches observed by laparoscopy may reflect the blood volume in the hepatic artery and portal vein supplying blood to the liver surface vessels.

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