经颈静脉肝内门体分流术对脾切除术后门静脉血栓患者食管静脉曲张再出血的预防价值  

Value of transjugular intrahepatic portosystemic shunt in the prevention of esophageal variceal rebleeding in patients with portal vein thrombosis after splenectomy

作　　者：李赵鹏 王广川[2] 张春清[2] LI Zhaopeng;WANG Guangchuan;ZHANG Chunqing(Department of Interventional Radiography,Qingdao Municipal Hospital,Qingdao,Shandong 266011,China;Department of Gastroenterology,Shandong Provincial Hospital,Jinan 250021,China)

机构地区：[1]青岛市市立医院微创介入治疗科,山东青岛266011 [2]山东省立医院消化科,济南250021

出　　处：《临床肝胆病杂志》2021年第6期1331-1335,共5页Journal of Clinical Hepatology

摘　　要：目的探讨预防脾切除术后门静脉血栓(PVT)患者发生食管静脉曲张再出血,行经颈静脉肝内门体分流术(TIPS)的技术成功率和结局。方法回顾性分析2009年12月—2017年1月山东省立医院收治的因预防食管静脉曲张再出血行TIPS的46例脾切除术后PVT患者的临床资料。根据TIPS是否成功,将患者分为TIPS成功组(38例)和TIPS失败组(8例),分析两组患者术后曲张静脉再出血、支架功能障碍、肝性脑病(HE)及生存状况。计量资料两组间比较采用配对t检验,计数资料两组间比较采用χ2检验。Kaplan-Meier曲线分析无曲张静脉再出血率、支架通畅率、无HE发生率和生存率。累积无再出血率和累积生存率比较采用log-rank检验。结果TIPS成功率为82.6%。TIPS成功组与失败组6、12、24个月累积无再出血率分别为94.3%、89.8%、89.8%和85.7%、85.7%、28.6%,两组比较差异有统计学意义(χ2=4.563,P=0.033)。TIPS成功组支架在6、12、24个月累积通畅率分别为79.3%、74.3%、69.0%,TIPS术后累积无HE发生率在6、12、24个月分别为72.1%、55.5%、55.5%。TIPS成功组与失败组6、12、24个月累积生存率分别为94.0%、94.0%、86.2%和71.4%、71.4%、71.4%,两组比较差异有统计学意义(χ2=4.988,P=0.026)。结论TIPS是预防脾切除术后PVT患者食管静脉曲张再出血的一种安全可行的方法。将TIPS与经皮经肝途径相结合可以促进技术成功。Objective To investigate the technical success rate and outcome of transjugular intrahepatic portosystemic shunt(TIPS)in preventing esophageal variceal rebleeding in patients with portal vein thrombosis(PVT)after splenectomy.Methods A retrospective analysis was performed for the clinical data of 46 patients with PVT after splenectomy who were admitted to Shandong Provincial Hospital from December 2009 to January 2017 and underwent TIPS to prevent esophageal variceal rebleeding.According to the success or failure of TIPS,the patients were divided into TIPS success group with 38 patients and TIPS failure group with 8 patients.The two groups were compared in terms of postoperative variceal rebleeding,stent dysfunction,hepatic encephalopathy(HE),and survival.The paired t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.The Kaplan-Meier curve was used to analyze variceal rebleeding-free rate,stent patency rate,HE-free rate,and survival rate,and the log-rank test was used for comparison of cumulative rebleeding-free rate and cumulative survival rate.Results The technical success rate of TIPS was 82.6%.There were significant differences in 6-,12-,and 24-month cumulative rebleeding-free rates between the TIPS success group and the TIPS failure group(94.3%/89.8%/89.8%vs 85.7%/85.7%/28.6%,χ2=4.563,P=0.033).In the TIPS success group,the 6-,12-,and 24-month cumulative stent patency rates were 79.3%,74.3%,and 69.0%,respectively,and the 6-,12-,and 24-month cumulative HE-free rates after TIPS were 72.1%,55.5%,and 55.5%,respectively.There were significant differences in 6-,12-,and 24-month cumulative survival rates between the TIPS success group and the TIPS failure group(94.0%/94.0%/86.2%vs 71.4%/71.4%/71.4%,χ2=4.988,P=0.026).Conclusion TIPS is a safe and feasible method for preventing esophageal variceal rebleeding in patients with PVT after splenectomy,and TIPS combined with a percutaneous transhepatic approach may promo

关 键 词：门体分流术 经颈静脉肝内 门静脉血栓 脾切除术 食管和胃静脉曲张 

分 类 号：R575.2[医药卫生—消化系统]