经皮经肝肝内门体分流术治疗脾切除术后合并慢性门静脉闭塞的门静脉高压症  

Percutaneous transhepatic intrahepatic portosystemic shunt for treatment of portal hypertension due to chronic portal vein occlusion after splenectomy

作　　者：罗骏阳 李名安[1] 王皓帆[1] 吴春[1] 李征然[1] 钱结胜[1] 关守海[1] 黄明声[1] 姜在波[1] 

机构地区：[1]中山大学附属第三医院介入血管科,广州510630

出　　处：《中华肝胆外科杂志》2017年第6期370-374,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：广东省科技计划项目（20128031800085）

摘　　要：目的评价经皮经肝肝内门体分流术（PTIPS）治疗脾切除术后合并慢性门静脉闭塞的门静脉高压症的可行性、有效性及安全性。方法回顾性分析中山大学附属第三医院2010年1月至2015年3月27例接受PTIPS治疗的脾切除术后合并慢性门静脉闭塞的门静脉高压症患者资料，观察患者手术成功率、并发症及临床随访结果。结果PTIPS手术成功25例（92．6％），失败2例。没有发生与手术直接相关的严重并发症。手术成功患者的门体静脉压力梯度（PPG）从分流前的平均（22．3±5．7）mmHg（1mmHg=0．133kPa）下降至分流后的平均（12．4±3．1）mmHg，差异有统计学意义（P〈0．05）。对25例手术成功的患者进行随访，中位随访时间为22个月。在随访期间，4例（16．0％）死亡，其中3例（12．0％）死于严重肝硬化所致肝功能衰竭，1例（4．0％）死于脑卒中。4例发生分流道支架闭塞，3例再次球囊扩张及支架植入后恢复通畅；另1例拒绝手术治疗，在术后36个月再次出血。2例（8．0％）术后出现了肝性脑病，1例经内科药物治疗后恢复；另1例发生了3级肝性脑病，术中测量PPG过低，于原分流道内植入一枚直径更小的覆膜支架后肝性脑病得到纠正。其他患者分流道保持通畅且原发症状消失。结论PTIPS治疗脾切除术后合并慢性门静脉闭塞的门静脉高压症是安全有效的方式。Objective To study the feasibility and efficacy of percutaneous transhepatic intrahepatie portosystemic shunt （PTIPS） in patients with portal hypertension due to chronic portal vein occlusion after splenectomy. Methods 27 patients who had portal hypertension due to chronic portal vein occlusion after splenectomy underwent PTIPS between December 2010 and March 2015. These patients were enrolled in this retrospective study. The success rates, efficacy, and complications were evaluated. Significance in the differences in the portosystemic pressure gradient （PPG） as measured before and after PTIPS procedure was assessed. Results PTIPS was successfully carried out in 25 patients but failed in 2. No fatal procedural complications were observed. The mean PPG dropped from （22.3±5.7） mmHg to （ 12.4±3.1 ） mmHg after successful VFIPS （ 1 mmHg =0. 133 kPa, P 〈0.05）. The median follow-up in the 25 patients with successful PTIPS were 22 months and there were 3 （ 12.0% ） deaths from liver failure due to severe cirrhosis, and 1 death （4.0%） from stroke during the follow-up period. Shunt dysfunction happened in 4 （ 16.0% ） patients. The original symptoms reoccurred in 2 patients （ 8.0% ） and the remaining patients were diagnosed by routine CT or US examination. Three patients recovered after shunt revision with stent implantation or balloon angioplasty, while one patient refused any further therapy except oral medication. This patient suffered from the first episode of rebleeding 36 months after PTIPS. Hepatic encephalopathy developed in 2 （ 8.0% ） patients, 1 patient recovered after medical treatment, while the other who developed Grade 3 hepatic eneephalopathy recovered after implanting a smaller cover stent. The remaining patients were asymptomatic with patent shunts. Conclusion PTIPS was a feasible, safe, and efficacious treatment for portal hypertension due to chronic portal vein occlusion after splenectomy.

关 键 词：静脉血栓形成 高血压 门静脉 脾切除术 门体静脉分流术 

分 类 号：R657.6[医药卫生—外科学]