经皮经肝肝内门体分流术治疗慢性门静脉闭塞并海绵样变性的症状性门静脉高压症  

Percutanous transhepatic intrahepatic portosystemic shunt for chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension

作　　者：李名安[1] 罗骏阳 张有用[2] 吴春[1] 钱结胜[1] 王皓帆[1] 陈俊伟[1] 黄明声[1] 关守海[1] 姜在波[1] 

机构地区：[1]中山大学附属第三医院介入血管外科,广州510630 [2]粤北人民医院介入科

出　　处：《中华放射学杂志》2018年第1期46-50,共5页Chinese Journal of Radiology

基　　金：广东省自然科学基金博士启动项目（2015A03031010171）

摘　　要：目的 探讨经皮经肝肝内门体分流术（PTIPS）在治疗慢性门静脉闭塞合并海绵样变性,所致症状性门静脉高压症的疗效及安全性.方法 回顾性分析2009年11月至2016年6月,接受PTIPS术治疗的38例慢性门静脉闭塞合并海绵样变性所致的症状性门静脉高压症患者的影像及临床资料.比较PTIPS术前后的门、体静脉压力梯度（PPG）变化.手术前后数据比较采用配对t检验,P〈0.05为差异具有统计学意义.随访并观察PTIPS术的疗效及手术相关并发症.结果38例患者中36例PTIPS获得成功;2例失败接受内科保守治疗（其中1例于术后25个月因再发消化道出血死亡）.36例手术成功的患者,术后PPG由术前（25.2±2.9）mmHg（1 mmHg=0.133 kPa）降至（13.2±1.3）mmHg,差异具有统计学意义（P〈0.05）.2例术中出现动脉损伤出血,行出血动脉栓塞及输血等对症处理后症状消失,1例术中误穿胆道导致胆道损伤,给予经皮经肝胆管引流术（PTBD）治疗.PTIPS术成功的36例患者,平均随访时间为（26.7±10.4）个月（3.0-74.0个月）.4例术后随访期间至少1次出现不同程度肝性脑病,其中1例给予分流道缩窄术.10例在随访期间发生分流道失功能（6例发生于术后1年内）,其中8例经分流道再次植入支架或球囊扩张后恢复、2例单纯给予抗凝及内科保守治疗;7例随访期间死亡.其中肝功能衰竭死亡4例,肝细胞癌死亡1例,再发消化道出血死亡1例,肾功能衰竭死亡1例.其余患者分流道均保持通畅且原发症状消失.结论 PTIPS术为慢性门静脉闭塞合并海绵样变性所致的症状性门静脉高压症患者提供了一种安全、有效的治疗方法,手术成功率高,近期疗效满意.Objective To investigate the efficacy and safety of percutanous transhepatic intrahepatic portosystemic shunt（PTIPS）for chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension.Methods The clinical and imaging data of 38 patients with chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension, who received PTIPS in our hospital from November 2009 to June 2016,were analyzed retrospectively.The differences of the portosystemic pressure gradient（PPG）measured before and after PTIPS procedure was analyzed by a paired samples t-test. All the patients were followed up and the curative effect and operation-correlated complications were observed.Results The PTIPS procedure was technically successful in 36 patients.The other two patients with unsuccessful PTIPS underwent medical treatment,and one of them died of recurrent variceal bleeding 25 months later. Effective portal decompression and free antegrade shunt flow were achieved in 36 patients with successful PTIPS.And the mean PPG was decreased from（25.2±2.9）to（13.2± 1.3） mmHg （1 mmHg=0.133 kPa） before and after PTIPS respectively and the difference was statistically significant（P〈0.05）.During the procedure,arterial hemorrhage occurred in two patients who subsequently underwent embolization. Biliary injury occurred in one case and percutanous transhepatic biliary drainage （PTBD）was then performed.The mean follow-up period of the 36 patients was（26.7±10.4）months（range from 3.0 to 74.0 months）.Hepatic encephalopathy appeared in 4 cases,among which,3 patients recovered after receiving medical treatment, while 1 patient experienced Grade 3 hepatic encephalopathy and recovered after implanting a smaller cover-stent.Shunt dysfunction occurred in 10 cases,of which 8 cases recovered after shunt revision with stent implantation or ballon angioplasty, while 2 cases underwent anticoagulation by warfarin only. During follow-up period, 7 patients died of liver failure�

关 键 词：高血压 门静脉 肝静脉闭塞性疾病 放射学 介入性 门体分流术 

分 类 号：R657.34[医药卫生—外科学]