直接性门腔静脉分流术中门静脉左、右支分流治疗门脉高压的临床对比研究  

Comparative study of clinical result of right and left portacaval shunts for portal hypertension by direct intrahepatic portacaval shunt

作　　者：潘红瑞 戴向晨[1] 范海伦[1] 梁晓宇[1] 罗光泽 罗宇东[1] 冯舟[1] 朱杰昌[1] 张益伟[1] 胡凡果[1] Pan Hongrui;Dai Xiangchen;Fan Hailun;Liang Xiaoyu;Luo Guangze;Luo Yudong;Feng Zhou;Zhu Jiechang;Zhang Yiwei;Hu Fanguo(Depatrment of Vascular Surgery,Tianjin Medical Univresity General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院血管外科,天津300052

出　　处：《中华血管外科杂志》2020年第3期164-168,共5页Chinese Journal of Vascular Surgery

基　　金：天津市科技支撑重点项目(16YFZCSY01080)。

摘　　要：目的探讨超声引导下直接性门腔静脉分流术(ugDIPS)治疗门脉高压症的疗效及门静脉穿刺靶点的选择对术后疗效的影响。方法回顾性分析天津医科大学总医院2015年5月至2018年8月应用ugDIPS治疗门脉高压所致急性上消化道出血29例患者的临床资料,根据术中门静脉穿刺靶点分为门静脉左支组(n=12)和门静脉右支组(n=17)。分别对两组手术成功率、术中并发症发生率、术中死亡率、术后症状缓解率、术前及术后的门脉压力进行统计学比较,并使用Kaplan-Meier曲线对术后肝性脑病发生率、再出血率及生存率进行分析。结果28例患者成功实施ugDIPS,手术成功率为96.6%(28/29,1例因术中门静脉右支破裂被迫放弃分流术),无术中死亡病例。两组间手术成功率、术中并发症率、术中死亡率比较,差异均无统计学意义(P均>0.05)。两组术后门脉压力与术前比较,差异均有统计学意义(P<0.05)。围术期症状缓解率96.4%(27/28),1例术后仍有消化道出血。两组间术后症状缓解率、围术期死亡率、并发症发生率比较,差异均无统计学意义(P均>0.05)。共27例患者获得随访,左支组11例,右支组16例。两组随访期肝性脑病发生率分别为18.2%(2/11)、12.5%(2/16);再出血率分别为18.2%(2/11)、6.25%(1/16);疾病相关死亡率分别为18.2%(2/11)、18.8%(3/16)。结论ugDIPS在超声引导下由肝内门静脉向肝后段下腔静脉建立门腔分流为可视操作,安全、有效。在分流前可先完成曲张静脉栓塞等断流操作,利于消化道出血的急诊治疗。门脉穿刺靶点的选择对术后分流效果及并发症的发生无明显影响。Objective To evaluate the efficacy of ultrasound-guided direct intrahepatic portacaval shunts(ugDIPS)in the treatment of portal hypertension and the postoperative effect of different portal vein puncture targets.Methods The clinical data of 29 patients with acute upper gastrointestinal bleeding due to portal hypertension treated with ugDIPS in Tianjin Medical University General Hospital from May 2015 to August 2018 were retrospective analyzed.According to intraoperative puncture target of portal vein(PV),all patients were divided into two groups:left branch of portal vein group(n=12)and right branch of portal vein group(n=17).The surgical success rate,intraoperative complication rate,intraoperative mortality rate,postoperative symptom relief rate,preoperative and postoperative portal pressure were statistically studied.Kaplan-meier curve was performed to assess the effect of different puncture targets on hepatic encephalopathy(HE),rebleeding and survival.Resultsug DIPS was successfully performed on 28 patients,the surgical success rate was 96.6%(28/29,one failed due to rupture of the right branch of portal vein during the operation),and there was no intraoperative death.The surgical success rate,intraoperative complication rate and intraoperative mortality between two groups were no significant differences(all P>0.05).Postoperative average portal pressure was significantly lower than preoperative in two groups(P<0.05).The symptom relief rate in perioperative period was 96.4%(27/28).One patient still had postoperative gastrointestinal bleeding.The postoperative symptom relief rate,perioperative mortality and complication rate were not significantly different between two groups(all P>0.05).A tatol of 27 patients were followed up for 1-39 months.There were 11 cases in left branch group and 16 cases in right branch group.During the period of follow-up,the HE rates were 18.2%(2/11)and 12.5%(2/16),respectively.The rebleeding rates were 18.2%(2/11)and 6.25%(1/16),respectively.The diease-related mortality rate were 18.2%

关 键 词：门脉高压 超声引导 肝内门腔分流术 

分 类 号：R657.3[医药卫生—外科学]