经颈静脉肝内门体分流术后肝移植单中心经验总结  

The single center experience of transjungular intohepatic portosystemic shuts for the bridge treatment to liver transplantation

作　　者：邓斐文[1] 陈焕伟[1] 甄作均[1] Deng Feiwen;Chen Huanwei;Zhen Zuojun(The Liver and pancreatic Surgery Department of The First People’s Hospital of Foshan.Foshan 528000,Guangdong,China.)

机构地区：[1]佛山市第一人民医院肝脏胰腺外科,广东佛山528000

出　　处：《实用器官移植电子杂志》2020年第4期261-266,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：2018年佛山市医学类科技攻关项目(2018AB003501)。

摘　　要：目的探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystem shunts,TIPS)在肝硬化失代偿期食管胃底静脉曲张破裂出血的治疗价值以及作为肝移植的桥接作用。方法回顾性分析佛山市第一人民医院2015年1月—2019年12月因肝硬化失代偿期并食管胃底静脉曲张破裂出血接受TIPS治疗的21例患者的临床资料。结果21例接受TIPS治疗的患者中男性19例,女性2例,中位年龄52(41~67)岁,单纯TIPS组15例,TIPS+肝移植(liver transplantation,LT)组6例,TIPS支架全部采用覆膜支架,其中6例TIPS后接受肝移植手术治疗,TIPS门静脉压力降低7~24 cmH2O(1 cmH2O=0.098 kPa)。TIPS术后中位随访时间单纯TIPS组为37.5(4~53)个月,TIPS+LT组为47(27~54)个月,单纯TIPS组4例肝细胞癌患者中2例术后分别发生肝细胞癌复发和上消化道再出血死亡,2例术后肝细胞癌进展,1例术后新发肝细胞癌,TIPS+LT组术后生存良好。结论TIPS在肝硬化失代偿期食管胃底静脉曲张破裂出血的患者止血治疗中具有明显的有效性,对等待肝移植的患者起到很好的桥接作用。Objective To explore the treatment value of transjugular introhepatic portosystemic shunts(TIPS)as the bridge to liver transplantation for the patients with acute variceal bleeding and decompensate liver cirrhosis.Methods The clinical data of the 21 patients with acute variceal bleeding who received TIPS at The First People’s Hospital of Foshan between January 2015 and December 2019 were analyzed retrospectively.Results Among the 21 patients,19 cases were male,2 cases were female.The median age was 52(41~67)years.There were 15 cases in the TIPS group,6 cases in the TIPS plus liver transplantation group.Cover stent was used in all patients.TIPS treatment decreased the portal vein pressure significantly(7 cmH2O to 24 cmH2O)(1 cmH2O=0.098 kPa).The median follow up time was 37.5 months for the TIPS group,and 27 months for the TIPS plus LT group respectively.There were 4 cases with hepatocellular carcinoma in the pure TIPS group,one died of tumor recurrence and acute variceal bleeding recurrence in the TIPS group.Two cases had tumor recurrence.One case had new occurrence of hepatocellular carcinoma after TIPS treatment in the TIPS group.The patients lived well in the TIPS plus liver transplantation group.Conclusion TIPS was with significant treatment value for the patients with acute variceal bleeding of decompensate liver cirrhosis,and TIPS also deserved as a bridge treatment for liver transplantation.

关 键 词：经静脉肝内门体分流术 急性食管胃底静脉曲张破裂出血 肝移植 治疗价值 

分 类 号：R657.3[医药卫生—外科学]