肝硬化患者自发性脾肾分流道干预思考与安全性分析  

Consideration and safety analysis of spontaneous splenorenal shunt intervention in patients with hepatocirrhosis

作　　者：薛文豪 刘仕睿 焦周阳[1] 徐鹏[1] 化召辉[1] 曹辉[1] 李震[1] Xue Wenhao;Liu Shirui;Jiao Zhouyang;Xu Peng;Hua Zhaohui;Cao Hui;Li Zhen(Department of Endovascular Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院腔内血管外科,河南郑州450052

出　　处：《中国血管外科杂志（电子版）》2023年第4期336-341,共6页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的比较不同干预措施治疗肝硬化患者自发性脾肾分流道(spontaneous splenorenal shunt,SSRS)的预后。方法回顾性分析2019年1月至2022年1月郑州大学第一附属医院收治的42例肝硬化合并SSRS患者的临床资料,根据治疗方案不同分为保守治疗组(19例)、单纯栓塞组(18例)和联合栓塞组(5例)。结果患者治疗均取得成功,症状均得到改善,无术中死亡、异位栓塞等并发症。术后随访1年,保守治疗组死亡2例,单纯栓塞组死亡4例,联合栓塞组死亡2例。单纯栓塞组与保守治疗组的生存率差异无统计学意义(P=0.076);Child-Puge分级与生存率相关(P<0.001),性别、分流道直径对患者生存时间没有明显影响(P>0.05)。结论选择性脾肾分流道栓塞对于肝功能尚可的患者是安全有效的,对于肝功能较差者应结合门静脉压力进行治疗。Objective To compare the prognosis of different intervention methods in the treatment of spontaneous splenorenal shunt(SSRS)in patients with hepatocirrhosis.Methods The clinical data of 42 patients with hepatocirrhosis and SSRS admitted to the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2022 were analyzed retrospectively.According to different treatment methods,they were divided into conservative treatment group(19 cases),simple embolization group(18 cases)and combined embolization group(5 cases).Results All patients were successfully treated,and symptoms were improved.There were no complications such as intraoperative death or ectopic embolism.After 1 year of follow-up,2 patients died in the conservative treatment group,4 patients died in the simple embolization group and 2 patients died in the combined embolization group.There was no significant difference in survival rate between the simple embolization group and the conservative treatment group(P=0.076).Child-Puge grade was related to survival rate(P<0.001),while gender and shunt diameter had no significant impact on patient survival time(P>0.05).Conclusion Selective splenorenal shunt embolization is safe and effective for patients with fair liver function,and patients with poor liver function should be treated with portal vein pressure.

关 键 词：肝硬化 脾肾分流道 门静脉高压 介入 

分 类 号：R575.2[医药卫生—消化系统]