经颈静脉肝内门体分流术治疗肝硬化静脉曲张出血的疗效及预后  

Effects of Transjugular Intrahepatic portosystemic shunt for variceal Hemorrhage in patients with liver Cirrhosis and prognostic factors

作　　者：张艳飞[1] 陈平[1] 王泽鑫[2] 李建明[2] ZHANG Yan-fei;CHEN Ping;WANG Ze-xin;LI Jian-ming(Department of gastroenterology,Hospital Affiliated to Inner Mongolia Medical University,Hohhot 010050,China;Department of interventional radiology,Hospital Affiliated to Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院消化科,1010050 [2]内蒙古医科大学附属医院介入科,2010050

出　　处：《现代消化及介入诊疗》2020年第10期1301-1305,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：内蒙古医科大学“科技百万工程”项目(YKD2018KJBW(LH)038)。

摘　　要：目的探讨分析经颈静脉肝内门体分流术(TIPS)治疗肝硬化静脉曲张出血的临床疗效及影响预后的因素。方法回顾性分析我院2013年3月至2018年12月因肝硬化静脉曲张出血而接受TIPS手术的患者35例,随访观察临床疗效及预后,运用寿命表法绘制累积生存率曲线,再分别对术后肝性脑病组和非肝性脑病组、死亡组和非死亡组患者的相关指标进行统计学分析,Logistic回归分析影响死亡的危险因素。结果35例患者中有12例(34.3%)发生肝性脑病,7例(20%)发生支架内血栓,随访期间死亡13例(37.1%),术后3个月、6个月及12个月的累积生存率分别为97%、91%及83%,死亡原因为消化道出血、肝性脑病、感染及肝癌。年龄(P=0.005)及Child-Pugh评分(P=0.026)在肝性脑病和非肝性脑病两组间具有统计学差异(P<0.05)。年龄(OR=1.126,95%CI 1.002~1.264,P=0.046)及MELD评分(OR=2.168,95%CI 1.045~4.498,P=0.038)是影响患者死亡的独立危险因素。结论TIPS治疗肝硬化静脉曲张出血安全有效,肝性脑病及支架内血栓是主要并发症,年龄及MELD评分是影响患者死亡的独立危险因素。Objective To investigate the clinical effect and prognostic factors of transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of cirrhotic variceal hemorrhage.Methods From March 2013 to December 2018,35 patients underwent TIPS operation due to variceal bleeding of liver cirrhosis in our hospital.The life table method was used to draw the cumulative survival rate curve,and then the relevant indexes of patients with postoperative hepatic encephalopathy group and non-hepatic encephalopathy group,the death group and non-death group were statistically analyzed respectively.The Logistic regression analysis was used to analyze the risk factors of death.Results There were 12 cases(34.3%)with hepatic encephalopathy,7 cases(20%)with intrastent thrombosis,13 cases(37.1%)of death with cumulative survival rate of 97%,91%and 83%in 3 months、6 months and 12 months after operation.The causes of death were gastrointestinal hemorrhage,hepatic encephalopathy,infection and liver cancer.Age(P=0.005)and ChildPugh score(P=0.026)were statistically different between hepatic encephalopathy and non-hepatic encephalopathy group(P<0.05).Age(OR=1.126,95%CI 1.002~1.264,P=0.046)and MELD score(OR=2.168,95%CI 1.045~4.498,P=0.038)was independent risk factor for patient mortality.Conclusions TIPS is safe and effective in the treatment for variceal hemorrhage in liver cirrhosis.Hepatic encephalopathy and intrastent thrombosis are major complications.Age and MELD score are independent risk factor for patient mortality.

关 键 词：经颈静脉肝内门体分流术 肝硬化静脉曲张出血 疗效 预后 

分 类 号：R575.2[医药卫生—消化系统]