经颈静脉肝内门体分流术治疗土三七所致肝窦阻塞综合征疗效分析  

Outcomes of transjugular intrahepatic portosystemic shunt in treatment of hepatic sinusoidal obstruction syndrome due to gynura segetum

作　　者：董振楠 吴军政 刘圣[2] 杨魏 施海彬[2] 周卫忠[2] Zhennan Dong;Junzheng Wu;Sheng Liu;Wei Yang;Haibin Shi;Weizhong Zhou(Department of Interventional Radiology,the Affiliated Suqian First People's Hospital of Nanjing Medical University,Jiangsu Suqian 223800;Department of Interventional Radiology,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Nanjing 210029,China)

机构地区：[1]南京医科大学附属宿迁第一人民医院介入放射科,江苏宿迁223800 [2]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《中华介入放射学电子杂志》2023年第1期25-29,共5页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗土三七所致肝窦阻塞综合征(hepatic sinusoidal obstruction syndrome,HSOS)的安全性和有效性。方法回顾性分析2016年12月至2020年8月因服用土三七导致HSOS的16例患者临床资料,其中男10例,女6例。所有患者均先行抗凝、保肝等保守治疗且效果不佳,而后接受TIPS治疗。评估TIPS技术成功、临床成功及并发症情况。结果所有患者均成功行TIPS手术。门静脉压力梯度(porto systemic gradient,PSG)由术前(36.2±5.6)mmHg降至术后(21.2±5.0)mmHg(P<0.05)。13例(81.3%)患者取得临床成功,术后1、3个月患者天冬氨酸转氨酶(aspartate aminotransferse,AST)、丙氨酸转氨酶(alanine aminotransferase,ALT)、总胆红素(total bilirubin,TBIL)、终末期肝病模型(end-stage liver disease,MELD)评分均低于TIPS治疗前。严重的短期并发症包括感染性休克1例和腹膜炎1例。结论在抗凝、保肝等保守治疗无效的情况下,TIPS治疗土三七致肝窦阻塞综合征是安全、有效的。Objective To investigate the safety and efficacy of transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of hepatic sinusoidal obstruction syndrome(HSOS)caused by gynura segetum.Methods From December 2016 to August 2020,the clinical data of 16 patients(10 males and 6 females)with HSOS caused by gynura segetum were retrospectively analyzed.All patients received TIPS treatment after poor response to conservative treatment.The technical success,clinical success of TIPS and procedure-related complications were evaluated.Results TIPS procedures were performed successfully in all patients.The portal pressure gradient(PPG)decreased from(36.2±5.6)to(21.2±5.0)mmHg(P<0.05).Clinical success was achieved in thirteen patients(81.3%).And one month and three months after the procedures,the patients'concentrations of aspartate aminotransferse(AST),alanine aminotransferase(ALT),total bilirubin(TBIL)and model for end-stage liver disease(MELD)scores were all significantly lower than those before the TIPS.The severe short-term complication included septic shock(n=1)and peritonitis(n=1).Conclusions In the case of ineffective conservative treatment such as anticoagulation and liver protecting treatment,TIPS was safe and effective in the management of HSOS due to gynura segetum.

关 键 词：肝静脉闭塞性疾病 门体分流术 经颈静脉肝内 土三七 

分 类 号：R657.3[医药卫生—外科学]