经颈静脉肝内门体分流术治疗肝硬化伴不同门静脉血栓分级的临床研究  

Clinical study of transjugular intrahepatic portosystemic shunt in the treatment of liver cirrhosis with different portal vein thrombosis grades

作　　者：李如春 胡继红[1] 潘文秋 卓松波 张玉博 田梽甫 LI Ruchun;HU Jihong;PAN Wenqiu;ZHUO Songbo;ZHANG Yubo;TIAN Zhifu(Department of Medical Imaging,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Interventional,Lincang People’s Hospital,Lincang,Yunnan Province 677000,China)

机构地区：[1]昆明医科大学第一附属医院医学影像科,云南昆明650032 [2]临沧市人民医院介入科,云南临沧677000

出　　处：《实用放射学杂志》2024年第10期1690-1694,共5页Journal of Practical Radiology

摘　　要：目的对比分析经颈静脉肝内门体分流术(TIPS)治疗肝硬化伴不同门静脉血栓(PVT)分级的临床特点及疗效。方法回顾性选取肝硬化伴消化道出血接受TIPS治疗的患者75例,依据PVT的Yerdel分级将患者分为Ⅰ型(34例)、Ⅱ型(25例)、Ⅲ型(16例)。分别于术后1、3、6个月及之后每6个月随访1次,比较3型PVT患者临床资料及TIPS的疗效。结果3型患者TIPS成功率均为100%。3型患者在血小板/淋巴细胞比值(PLR)及不同Child-Pugh分级占比上存在差异(P<0.05);TIPS术后,门静脉压力较术前均下降(P<0.001)。然而,3型患者在术后生存率、再出血率、显性肝性脑病发生率、支架失功能率、血栓完全再通率、再血栓形成方面差异无统计学意义(P>0.05)。结论3型患者TIPS成功率均较高,术后门静脉压力均显著下降,但术后疗效相比无显著性差异。虽然肝硬化PVT患者在实施TIPS时具有挑战性,但仍需重塑门静脉,使患者获益。Objective To compare and analyze the clinical characteristics and efficacy of transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of liver cirrhosis with different portal vein thrombosis(PVT)grades.Methods A retrospective analysis was performed on 75 patients with liver cirrhosis and gastrointestinal bleeding who received TIPS.According to the Yerdel scale of PVT,the patients were divided into typeⅠ(34 cases),typeⅡ(25 cases)and typeⅢ(16 cases).The patients were followed up 1,3,6 months after TIPS and every 6 months thereafter to compare the clinical data and the efficacy of TIPS in three types of PVT patients.Results The success rate of TIPS in three types of patients was 100%.There were differences in platelet to lymphocyte ratio(PLR)and proportion of different Child-Pugh grades among the three types of patients(P<0.05).After TIPS,portal vein pressure was decreased compared with that before TIPS(P<0.001).However,there were no significant differences in postoperative survival rate,rebleeding rate,over hepatic encephalopathy rate,stent dysfunction rate,thrombus complete recanalization rate and thrombus recurrence rate(P>0.05).Conclusion The success rate of TIPS in three types of patients is higher,and the portal vein pressure is decreased significantly after TIPS,but there are no significant differences in the postoperative efficacy.Although the implementation of TIPS in cirrhotic PVT patients is challenging,it is still worth the effort to reshape the portal vein for the benefit of patients.

关 键 词：肝硬化 门静脉血栓 消化道出血 经颈静脉肝内门体分流术 

分 类 号：R575.2[医药卫生—消化系统] R573.2[医药卫生—内科学] R815[医药卫生—临床医学]