应用覆膜支架TIPS治疗不同类型慢性门静脉血栓术后肝性脑病发生探讨  

A preliminary study on the occurrence of hepatic encephalopathy after TIPS using covered stent for different types of chronic portal vein thrombosis

作　　者：赵洪伟 刘福全[1] 岳振东[1] 王磊[1] 范振华[1] 董成宾 

机构地区：[1]首都医科大学附属北京世纪坛医院介入科,100038

出　　处：《介入放射学杂志》2014年第8期672-678,共7页Journal of Interventional Radiology

基　　金：2010年北京市科技计划项目"首都特色临床医学应用发展"基金资助项目(Z101107050210023);首都医科大学附属北京世纪坛医院院级课题基金(2011-C18)

摘　　要：目的通过建立慢性门静脉血栓解剖分型指导临床TIPS操作,探讨分析不同类型门静脉血栓术后肝性脑病(HE)的发生与TIPS术式选择的关系。方法 2010年6月—2013年6月收治慢性门静脉血栓患者73例,行Fluency覆膜支架TIPS治疗。根据门静脉系统血栓不同部位,建立门静脉系统血栓解剖分型,评估TIPS手术前后门静脉压力变化、不同类型血栓患者接受TIPS治疗后15 d和3、6个月出现HE状况及病例数,并进行同一时间组间和不同时间变化对比。结果 TIPS治疗中Ⅰ型患者的分流前、后的门静脉压力分别为(42.7±9.6)和(35.0±6.7)cm H2O,差异有统计学意义(P<0.01);Ⅱ型患者分别为(39.8±5.5)和(31.0±5.7)cm H2O,差异有统计学意义(t=17.2,P<0.01);Ⅲ型患者TIPS分别为(43.2±5.8)和(32.4±5.0)cm H2O,差异有统计学意义(t=25.0,P<0.01);Ⅳ型患者分别为(43.0±3.7)和(36.6±6.6)cm H2O,差异有统计学意义(t=4.26,P<0.01)。术后15 d时发生轻微HE(MHE)的前三者为Ⅳ、Ⅰ和Ⅲb型,发生Ⅰ期HE前三者为Ⅱa、Ⅲb和Ⅰ型,发生Ⅱ期HE的前三者为Ⅱb、Ⅲb和Ⅰ型;术后3个月时发生MHE的前三者为Ⅲa、Ⅱa和Ⅱc型,发生Ⅰ期HE的前三者为Ⅲa、Ⅱb和Ⅳ型,发生Ⅱ期HE的前三者为Ⅱa、Ⅱb和Ⅲb型;术后6个月时发生MHE的前三者为Ⅱa、Ⅱc和Ⅲb型,发生I期HE的前三者为Ⅱb、Ⅰ和Ⅲb型,发生Ⅱ期HE的前三者为Ⅱb、Ⅲb和Ⅰ型;且Ⅱb、Ⅲb和Ⅰ型TIPS术后HE持续时间较长。结论建立合理的慢性门静脉系统血栓解剖分型可以有效的指导临床TIPS的应用,术后HE在单纯门静脉主干和单纯肠系膜上静脉血栓中的发生概率较高。Objective To establish an anatomical classification of chronic portal vein thrombosis （PVT） in order to guide the transjugular intrahepatic portasystemic shunt （TIPS） manipulation, and to analyze the correlation between anatomical classification of PVT and the occurrence of hepatic encephalopathy （HE） after TIPS. Methods During the period from June 2010 to June 2013 at authors’ hospital, TIPS with fluency covered stent was carried out in a total of 73 patients with chronic portal vein thrombosis. Based on the location of portal vein thrombosis, the anatomical classification of portal vein thrombosis （PVT-type） was initially established. The changes in portal vein pressure after TIPS were evaluated. The occurrence of HE at 15 days and at 3 and 6 months after TIPS in patients with different PVT-type was statistically analyzed. As the understanding of 0-phase minimal hepatic encephalopathy （MHE） was deepened, the authors added a subdivision to the 0-phase, including normal cognitive function state and minimal hepatic encephalopathy （MHE） into West - Haven grading to further precisely assess the hepatic encephalopathy. Using＆amp;nbsp;paired samples t-test, the changes of portal vein pressure after TIPS were evaluated. The grading of hepatic encephalopathy and the number of occurrence after TIPS were particularly recorded, the results were compared between groups at the same time and between the types at different times. Results The preoperative and postoperative portal vein pressure in type Ⅰ patients receiving TIPS therapy was （42.7 ± 9.6） and （35.0 ± 6.7） cm H2O respectively, the difference was statistically significant （t = 7.61, P 〈0.01）;in typeⅡpatients it was（39.8 ± 5.5） and（31.0 ± 5.7） cm H2O respectively（t=17.2, P〈0.01）;in type Ⅲpatients it was （43.2 ± 5.8） and （32.4 ± 5.0） cm H2O respectively （t = 25.0, P 〈 0.01）; and in type Ⅳpatients it was （43.0 ± 3.7） and （36.6 ± 6.6） cm H2O respectively （t = 4.26, P 〈0.01�

关 键 词：肝性脑病 经颈静脉肝内门体静脉分流术 门静脉血栓 覆膜支架 

分 类 号：R657.34[医药卫生—外科学] R747.9[医药卫生—临床医学]