经颈静脉肝内门体静脉分流术联合胃左静脉栓塞术对肝硬化患者肝功能的影响  

Effects of transjugular intrahepatic portosystemic shunt combined with left gastric vein embolization on theliver function of patients with liver cirrhosis

作　　者：宦徽 童欢 魏波 黄志寅 李晓丹 郭林杰 李晓萍 吴浩 唐承薇 

出　　处：《中华消化杂志》2017年第6期404-410,共7页Chinese Journal of Digestion

基　　金：四川省科技支撑计划（2016SZ0041）;四川省科技厅应用基础项目（2016JY0191）;成都市科技局科技惠民研发项目（2015-HM01-00016-SF）

摘　　要：目的比较经颈静脉肝内门体静脉分流术（TIPs）与TIPS联合胃左静脉栓塞术（LGVE）对肝硬化患者肝功能的影响。方法本研究为回顾性分析。纳入2014年9月至2015年9月行TIPS的31例肝硬化患者和行TIPS联合LGVE的29例肝硬化患者，收集患者术前和术后的肝功能数据，获得Child—Pugh和终末期肝病模型（MELD）评分。统计学方法采用t检验或卡方检验。结果TIPS组与TIPS联合LGVE组术前门静脉压分别为（28．48±2．77）和（28．38±2．92）mmHg（1mmHg=0．133kPa），术后分别降为（17．81±1．47）和（17．97±2．04）mmHg，差异均有统计学意义（f=18．908、11．648，P均〈0．01）。术后12个月，TIPS联合LGVE组的Chil＆Pugh评分为（5．69±1．19）分，低于术前的（7．03±1.76）分，差异有统计学意义（t=3．398，P=0．001）；也低于TIPS组同=个时间的（6．52±1．54）分，差异有统计学意义（t=2．303，P=0．025）。术后12个月，TIPS联合LGVE组Child—Pugh分级A级患者的构成比为89．7％（26／29），高于术前的44．8oA（13／29），差异有统计学意义（x2=13．228，P％0．01）；B级患者的构成比为6．9％（2／29），低于术前的41．4％（12／29），差异有统计学意义（y2=9．416，P〈0．01）。结论TIPS可显著降低肝硬化患者的门静脉压，且不导致患者长期的肝功能减退；TIPS联合LGVE在改善肝硬化患者的肝功能，特别是Child—Pugh分级A和B级患者的远期肝功能上优于单纯TIPS组。Objective To compare the difference in the effects on liver function between transjugular intrahepatic portosystemic shunt （TIPS） alone and the combination of TIPS and left gastric vein embolization （LGVE） in patients with liver cirrhosis. Methods This research was a retrospective study. From September 2014 to September 2015, 31 patients with liver cirrhosis underwent TIPS （TIPS group） and 29 patients with liver cirrhosis underwent TIPS combined with LGVE （TIPS＋LGVE group） were enrolled. The data of the liver function of patients before and after operation were collected and the Child-Pugh score and model for end-stage liver disease （MELD） were also calcuiated. Student＇s t test and chi-squared test were performed for statistical analysis. Results The preoperative portal vein pressures of TIPS group and TIPS＋LGVE group were （28.48±2.77） mmHg （1 mmHg=0. 133 kPa） and （28.38± 2.92） mmHg, respectively. And after operation, the portal vein pressures decreased to （17. 81 ±1.47） mmHg and （17. 97± 2. 04） mmHg, respectively, and the differences were both statistically significant （t=18. 908 and 11. 648, both P〈0.01）. At 12 months after operation, Child Pugh score of TIPS＋LGVE group was 5.69±1.19, which was significantly lower than that before operation （7.03±1.76）, and the difference was statistically significant （t： 3. 398, P： 0. 001）, which was also lower than that of TIPS group at the same time point （6.52± 1.54）, and the difference was statistically significant （t： 2. 303, P=0. 025）. At 12 months after operation, the component ratio of patients with Child-Pugh grade A of TIPS-kLGVE group was 89.7% （26/29）, which was higher than that before operation （44.8%, 13/29）, and the difference was statistically significant （X2 = 13. 228, P〈0.01）. The component ratio of patients with Child-Pugh grade B was 6.90% （2/29）, which was lower than that before operation （41.4 % 12/29）, and the difference was statistically significant

关 键 词：门体分流术 经颈静脉肝内 胃左静脉栓塞术 静脉曲张性出血 肝硬化 肝功能 

分 类 号：R575.2[医药卫生—消化系统]