经颈静脉肝内门体分流术对进展期肝硬化患者肝肾功能的影响  

Effect of transjugular intrahepatic portosystemic shunt on liver and renal functions of cirrhosis patients:report of 86 cases

作　　者：李灵敏[1] 肖天利[1] 廖化禹[1] 陈磊[1] 龙庆林[1] 汪荣泉[1] 陈文生[1] 

机构地区：[1]第三军医大学西南医院全军消化内科研究所,重庆400038

出　　处：《第三军医大学学报》2010年第20期2235-2238,共4页Journal of Third Military Medical University

基　　金：第三军医大学西南医院院管课题(SWH2005A017)~~

摘　　要：目的观察经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗进展期肝硬化门脉高压前后对肝肾功能的影响及临床疗效分析。方法对西南医院消化内科从2004年1月至2009年3月86例诊断为肝硬化,反复发生呕血、便血的患者行TIPS治疗,观察临床疗效、术后并发症及手术前后肝功能和肾功能的变化。结果手术后门静脉压力明显降低,由术前(29.8±3.2)mmHg降为术后(17.4±0.7)mmHg(P<0.05),肝功能白蛋白(Alb)、谷丙转氨酶(ALT)所好转,谷草转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)在术后有一定程度上升,但在术后半年的观测中逐渐下降。肾功能尿素氮(UN)、肌酐清除率(Cr)在术后1周时明显下降(P<0.05),至半年的随访中也有下降趋势。在2年的随访中81例患者完成随访,再次出血率9.3%,肝性脑病的发生率为10.4%,重症肝炎2例,发现肝癌3例,12例患者因支架堵塞需要行TIPS修正术。结论 TIPS术后近期肝功能轻度损害,但无手术相关并发症出现,肾功能术后有所改善。该手术是治疗肝硬化门静脉高压症尤其是上消化道出血安全有效的方法。Objective To explore the outcome of transjugular intrahepatic portosystemic shunt（TIPS）in the treatment of portal hypertension patients with cirrhosis and investigate the changes of liver and renal functions.MethodsEighty-six patients with portal hypertension due to liver cirrhosis in our department from January 2004 to March 2009 were involved in this study.The functions of liver and renal were observed before and after TIPS.The incidence of complications and the clinical outcome were investigated.ResultsPortosystemic gradient was decreased after TIPS significantly,from 29.8±3.2 mmHg to 17.4±0.7 mmHg.Postoperative ALT and Alb were improved.Postoperative AST,TBIL and DBIL were higher than those before operation,but these values were decreased during the follow-up of 3.47±2.11 years.And the renal function was also improved.During the follow-up,the incidence of rebleeding was 9.3%,and that of encephalopathy was 10.4%.Severe hepatitis occurred in 2 patients,and shunt abnormalities in 12 patients.ConclusionLiver enzymes are increased in those patients after TIPS,but there is no related complication seen.Patients also have an improvement in renal function.TIPS is a safe and effective treatment for portal-hypertension,particularly in upper gastrointestinal bleeding.

关 键 词：肝硬化 经颈静脉肝内门体分流术 适应证 

分 类 号：R615[医药卫生—外科学] R657.3[医药卫生—临床医学]