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目的探讨门静脉留置全埋植式给药装置（ＩＤＤＳ）在肝癌诊治中的特殊临床价值．方法剖腹手术肝癌患者４０例，术中经胃网膜右静脉插管至门静脉主干，导管与埋植于腹壁皮下的注药盒连接，术后经其进行自由门静脉压（ＦＰＰ）的直接动态观察、门静脉造影及保肝治疗．结果２４例肝癌患者伴有门静脉高压（ＦＰＰ≥２４５ｋＰａ），８例ＦＰＰ≥３４３ｋＰａ者术后全部发生上消化道出血，而３２例ＦＰＰ＜３４３ｋＰａ者均未发生出血．肝癌切除、肝动脉栓塞化疗均造成ＦＰＰ升高．门静脉显影良好，显影率分别为Ⅰ级０％，Ⅱ级２０％，Ⅲ级５２５％，Ⅳ级２７５％，尚发现门静脉主干癌栓６例，门静脉逆肝血流８例．门静脉注射地塞米松组２６例中仅２例发生肝切除后肝衰，而历史对照组４０例中发生１１例（Ｐ＜００５）．结论肝癌术中门静脉留置ＩＤＤＳ，对于术后门静脉血流动力学研究及上消化道出血和肝衰的防治，都具有特殊临床价值．
Objective To investigate the special clinical value of portal vein indwelling implanted device (IDDS) in the diagnosis and treatment of liver cancer. Methods 40 patients undergoing laparotomy underwent laparotomy. During operation, the right gastroepiploic vein was inserted into the main trunk of the portal vein. The catheter was connected with the injection box implanted subcutaneously in the abdomen wall. The direct dynamic observation of free portal vein pressure (FPP) was performed after operation. , portal vein angiography and liver protection treatment. Results 24 patients with hepatocellular carcinoma were associated with portal hypertension (FPP ≥ 2 45 kPa). Eight patients with FPP ≥ 3 43 kPa all experienced upper gastrointestinal bleeding, while 32 patients with FPP <3 43 kPa did not have bleeding. Hepatocellular carcinoma resection and hepatic artery embolization chemotherapy all caused elevated FPP. The portal vein was well developed, and the visualization rate was Grade I 0%, Grade II 20%, Grade III 52% 5%, Grade IV Grade 27 5%. Still, portal vein cancer thrombus was found in 6 cases, portal vein blood flow in 8 cases. Only 2 out of 26 portal vein dexamethasone groups had hepatic failure after hepatectomy, compared with 11 in 40 patients in the historical control group (P<005). Conclusion The IDDS of portal vein in hepatocellular carcinoma has special clinical value for the postoperative portal hemodynamic study and the prevention and treatment of upper gastrointestinal bleeding and hepatic failure.