限制性扩张支架对肝硬化门静脉高压经颈静脉肝内门体分流患者预后的影响  

Impact of restrictive expansion stent on prognosis of cirrhosis patients with portal hypertension after transjugular intrahepatic portosystemic shunt

作　　者：江晴贵 李建军[2] 郑晖[1] 黄兢姚[1] 黄宁[1] 杨维竹[1] JIANG Qinggui;LI Jianjun;ZHENG Hui;HUANG Jingyao;HUANG Ning;YANG Weizhu(Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou 350001, China;Center for Interventional Oncology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China)

机构地区：[1]福建医科大学附属协和医院介入科,福建福州350001 [2]首都医科大学附属北京佑安医院肿瘤微创介入中心,北京100069

出　　处：《中国介入影像与治疗学》2021年第4期193-197,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的观察经颈静脉肝内门体分流术(TIPS)治疗肝硬化门静脉高压术中限制性扩张支架对术后肝功能、并发症及生存率的影响。方法回顾性分析213例因肝硬化门静脉高压接受TIPS治疗患者,根据术中是否对覆膜支架进行限制性扩张分为限制组与对照组,经匹配后最终每组纳入53例。术后规律随访,对比2组肝功能、消化道再出血、肝性脑病(HE)发生率及死亡率差异;以COX回归分析观察生存率影响因素。结果对照组术后3、7天谷丙转氨酶(GPT)高于限制组(P=0.04、0.04),其他各时间点组间肝功能指标差异均无统计学意义(P均>0.05)。术后6个月、1年及2年,限制组免于HE累积发生率为88.60%、79.10%和68.50%,对照组为90.50%、82.70%和75.50%;限制组免于消化道再出血累积发生率为92.30%、90.30%和90.30%,对照组为96.00%、87.80%和76.60%(P均>0.05)。限制组术后1、2、3年累积生存率分别为92.10%、84.30%和81.20%,对照组为94.30%、82.10%和70.90%(P>0.05)。年龄和总胆红素(TBIL)为TIPS术后患者生存率的独立影响因素(P均<0.05)。结论限制性扩张支架可抑制肝硬化门静脉高压患者TIPS术后短期肝功能急剧受损,对中远期肝功能及预后无明显影响。Objective To explore the impact of restrictive expansion stent on postoperative liver function,complications and survival rate after transjugular intrahepatic portosystemic shunt(TIPS)for treating cirrhosis with portal hypertension.Methods Data of 213 patients with liver cirrhosis and portal hypertension who received TIPS were retrospectively analyzed.According to whether the stent graft was restrictively expanded during TIPS procedures,the patients were divided into restricted group and control group.After data matching,53 cases were included in each group.The patients were all regularly followed-up after TIPS,and liver function,gastrointestinal rebleeding,hepatic encephalopathy(HE)incidences and mortalities were compared between groups.COX regression model was used to observe the impact factors for survival.Results Glutamic-pyruvic transaminase(GPT)was higher in control group than in restriction group 3 and 7 days after TIPS operation(P=0.04,0.04),but no significant difference of liver function indexes was found between groups at other time points(all P>0.05).The cumulative incidence free of HE in restricted group was 88.60%,79.10%and 68.50%,respectively,which was 90.50%,82.70%and 75.50%in control group 6 months,1 year and 2 years after TIPS,respectively.The cumulative incidence free of gastrointestinal rebleeding in restricted group was 92.30%,90.30%and 90.30%,which was 96.00%,87.80%and 76.60%in control group 6 months,1 year and 2 years after TIPS(all P>0.05),respectively.The cumulative survival rate 1,2 and 3 years after TIPS operation was 92.10%,84.30%and 81.20%in restricted group,which was 94.30%,82.10%and 70.90%in control group,respectively(all P>0.05).COX regression model analysis results showed that age and total bilirubin(TBIL)were independent impact factors of survival rate after TIPS(both P<0.05).Conclusion Restrictive expansion stent could reduce short-term liver function damage in patients with cirrhosis and portal hypertension after TIPS,but had no significant impact on the medium-and long-term liv

关 键 词：肝硬化 门体分流术 经颈静脉肝内 高血压 门静脉 支架 

分 类 号：R657.3[医药卫生—外科学] R815[医药卫生—临床医学]