中国门静脉高压症经颈静脉肝内门体分流术治疗现状的调查分析  

Investigation and analysis of the current status of transjugular intrahepatic portosystemic shunt treatment for portal hypertension in China

作　　者：郭浩卓 牛猛[1] 邵海波[1] 韩新巍[2] 赵剑波[3] 孙军辉[4] 方主亭[5] 熊斌 朱晓黎[7] 任伟新[8] 袁敏[9] 于世平[10] 吕维富 张学强[12] 张春清[13] 李雷[14] 罗薛峰 宋于生[16] 马亦龙[17] 党彤[18] 向华[19] 晋云 薛挥[21] 金桂云[22] 李肖[23] 李佳睿[24] 周石 于长路 何松[27] 于雷[28] 祖红梅 马军[30] 雷彦明[31] 徐克[1] 祁小龙 Guo Haozhuo;Niu Meng;Shao Haibo;Han Xinwei;Zhao Jianbo;Sun Junhui;Fang Zhuting;Xiong Bin;Zhu Xiaoli;Ren Weixin;Yuan Min;Yu Shiping;Lyu Weifu;Zhang Xueqiang;Zhang Chunqing;Li Lei;Luo Xuefeng;Song Yusheng;Ma Yilong;Dang Tong;Xiang Hua;Jin Yun;Xue Hui;Jin Guiyun;Li Xiao;Li Jiarui;Zhou Shi;Yu Changlu;He Song;Yu Lei;Zu Hongmei;Ma Jun;Lei Yanming;Xu Ke;Qi Xiaolong(Department of Interventional Therapy,the First Hospital of China Medical University,Shenyang 110001,China;Department of Interventional Therapy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Interventional Therapy,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Hepatobiliary and Pancreatic Intervention Center,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Interventional Radiology,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Interventional Therapy,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Interventional Therapy,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Interventional Therapy,the First Affiliated Hospital of Xinjiang Medical University,Wulumuqi 830054,China;Department of Interventional Therapy,Shanghai Public Health Clinical Centre Affiliated to Fudan University,Shanghai 201508,China;Department of Interventional Therapy,Second Hospital of Shanxi Medical University,Taiyuan 030013,China;Department of Interventional Therapy,the First Affiliated Hospital of USTC,Hefei 230001,China;Department of Gastroenterology,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Interventional Therapy,the First Hospital of Lanzhou University,Lanzhou 730030,China;Department of Digestion,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Interventional Therapy,Ganzhou

机构地区：[1]中国医科大学附属第一医院介入治疗科,沈阳110001 [2]郑州大学第一附属医院介入科,郑州450052 [3]南方医科大学南方医院介入治疗科,广州510515 [4]浙江大学医学院附属第一医院肝胆胰介入中心,杭州310003 [5]福建省立医院介入放射科,福州350001 [6]广州医科大学附属第一医院介入科,广州510120 [7]苏州大学附属第一医院介入科,苏州215006 [8]新疆医科大学第一附属医院介入科,乌鲁木齐830054 [9]上海市公共卫生临床中心介入科,上海201508 [10]山西医科大学第二医院介入治疗科,太原030013 [11]中国科学技术大学附属第一医院介入科,合肥230001 [12]河北医科大学附属第二医院消化内科,石家庄050000 [13]山东省立医院消化内科,济南250021 [14]兰州大学第一医院介入科,兰州730030 [15]四川华西医院消化内科,成都610041 [16]赣州市人民医院微创介入科,赣州341009 [17]广西医科大学附属肿瘤医院介入科,南宁530021 [18]包头医学院附属第二医院消化内科,包头014031 [19]湖南省人民医院介入医学中心,长沙410002 [20]云南省第一人民医院肝胆外科,昆明650034 [21]西安交通大学第一附属医院消化内科,西安710061 [22]海南医学院附属第一医院介入治疗科,海口570102 [23]中国医学科学院肿瘤医院介入科,北京100020 [24]吉林大学第一医院介入科,长春130061 [25]贵州医科大学附属医院介入科,贵阳550004 [26]天津市第三医院放射科,天津300250 [27]重庆医科大学附属第二医院消化内科,重庆400010 [28]哈尔滨医科大学第四医院感染科,哈尔滨150001 [29]青海省第四人民医院消化科,西宁810007 [30]宁夏回族自治区人民医院介入科,银川750002 [31]西藏自治区人民医院介入放射科,拉萨850010 [32]东南大学附属中大医院门静脉高压中心,南京210009

出　　处：《中华放射学杂志》2024年第4期437-443,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(62371474);国家重点研发计划(2023YFC2308405)。

摘　　要：目的探讨经颈静脉肝内门体分流术(TIPS)在中国用于门静脉高压症治疗中的现状,以帮助推进TIPS在国内的发展。方法本研究由中国门静脉高压联盟(CHESS)发起,通过问卷调查的方式全面调查了国内开展门静脉高压症TIPS手术的基本情况,包括手术例数、主要适应证、Early/优先TIPS的开展、门静脉海绵状变性的TIPS手术、侧支循环栓塞、术中门静脉压力梯度测定、常用支架类型、常规抗凝及时间、术后随访、存在的阻碍、国产器械的应用等。结果调查显示,2021年全国参与调研的545家医院共开展13527例TIPS手术,94.1%的医院常规进行TIPS术后随访,大多数医院认为TIPS手术的最主要适应证是控制急性出血(42.6%)和预防再出血(40.7%),48.1%的医院开展了Early/优先TIPS,53.0%的医院开展了门静脉海绵状变性的TIPS手术,选择术中常规栓塞侧支循环的占81.0%,其中大多数以弹簧圈和生物胶为栓塞材料,78.5%的医院常规开展术中门体压力梯度测定,TIPS支架的选用上,57.1%的医院会选择Viattor专用支架,57.2%的医院会选择TIPS术后常规抗凝,抗凝时间集中在3~6个月(55.4%),TIPS术受限制的原因以费用问题(72.3%)与相关科室医师认识不充分(77.4%)为主,大部分医院对TIPS术中使用国产器械接受度较高(92.7%)。结论本次调研显示TIPS治疗是我国门静脉高压症治疗的重要组成部分,但是开展TIPS的总例数与门静脉高压症的总发病人数相差较大,未来仍需推广普及TIPS技术,进一步规范化手术适应证、手术常规操作及器械应用。ObjectiveTo investigate the current situation of the use of transjugular intrahepatic portosystemic shunt(TIPS)for portal hypertension,which should aid the development of TIPS in China.MethodsThe China Portal Hypertension Alliance(CHESS)initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research.The survey included the following:the number of surgical cases,main indications,the development of Early-TIPS,TIPS for portal vein cavernous transformation,collateral circulation embolization,intraoperative portal pressure gradient measurement,commonly used stent types,conventional anticoagulation and time,postoperative follow-up,obstacles,and the application of domestic instruments.ResultsAccording to the survey,a total of 13527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021,and 94.1%of the hospital had the habit of routine follow-up after TIPS.Most hospitals believed that the main indications of TIPS were the control of acute bleeding(42.6%)and the prevention of rebleeding(40.7%).48.1%of the teams carried out early or priority TIPS,53.0%of the teams carried out TIPS for the cavernous transformation of the portal vein,and 81.0%chose routine embolization of collateral circulation during operation.Most of them used coils and biological glue as embolic materials,and 78.5%of the team routinely performed intraoperative portal pressure gradient measurements.In selecting TIPS stents,57.1%of the hospitals woulel choose Viator-specific stents,57.2%woulel choose conventional anticoagulation after TIPS,and the duration of anticoagulation was between 3-6 months(55.4%).The limitation of TIPS surgery was mainly due to cost(72.3%)and insufficient understanding of doctors in related departments(77.4%).Most teams accepted the domestic instruments used in TIPS(92.7%).ConclusionsThis survey shows that TIPS treatment is an essential part of treating portal hypertension in China.The total number of TIPS cases is far from th

关 键 词：高血压 门静脉 经颈静脉肝内门体分流术 应用现状 问卷调查 

分 类 号：R575.2[医药卫生—消化系统]