TIPS治疗肝硬化伴或不伴门静脉血栓临床对比研究  

TIPS for the treatment of cirrhosis with or without portal vein thrombosis:a comparative study

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,First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan Province 650032,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

出　　处：《介入放射学杂志》2024年第10期1101-1106,共6页Journal of Interventional Radiology

摘　　要：目的分析TIPS治疗肝硬化伴或不伴门静脉血栓形成(portal vein thrombosis,PVT)的临床特点及疗效。方法回顾性分析2018年10月至2022年10月在昆明医科大学第一附属医院接受TIPS治疗的肝硬化伴消化道出血患者193例,按术前有无PVT分为非PVT组118例,PVT组75例。分别于术后1、3、6个月及之后每6个月随访,观察PVT对肝硬化患者临床特征及TIPS术后疗效的影响。结果两组患者手术成功率均为100%。PVT组行脾脏切除或行分脾动脉栓塞术占26.7%(20/75),高于非PVT组的13.6%(16/118),差异有统计学意义(χ^(2)=5.192,P=0.023)。PVT组患者术前Child-Pugh评分、MELD评分和MELD-Na+评分分别为(8.1±1.9)分、(9.2±8.0)分、(9.2±8.0)分,均高于非PVT组的(7.4±1.9)分、(7.7±5.8)分、(7.7±5.8)分,差异有统计学意义(P<0.05)。PVT组显性肝性脑病发生率33.3%(25/75)高于非PVT组19.5%(23/118),差异有统计学意义(P=0.030)。而术后生存率、再出血率和支架失功能率,两组差异无统计学意义(P>0.05)。结论TIPS用于治疗肝硬化PVT伴消化道出血安全、有效;PVT患者的肝功能更差,TIPS术后显性肝性脑病发生率更高。Objective To compare the clinical characteristics of cirrhosis with or without portal vein thrombosis(PVT),and to analyze the therapeutic effect of transjugular intrahepatic portosystemic shunt(TIPS)in treating cirrhosis with or without PVT.Methods The clinical data of 193 patients with cirrhosis complicated by gastrointestinal bleeding,who received TIPS from October 2018 to October 2022,were retrospectively analyzed.According to the presence or absence of PVT before TIPS,the patients were divided into non-PVT group(n=118)and PVT group(n=75).After TIPS,the patients were followed up at one,3,6 months and every 6 months thereafter.The effect of PVT on the clinical characteristics of cirrhosis patients and on the therapeutic efficacy after TIPS were analyzed.Results The success rate of TIPS was 100%in both groups.The proportion of carrying out splenectomy or partial splenic artery embolization(PSE)in PVT group was 26.7%(20/75),which was obviously higher than 13.6%(16/118)in non-PVT group,the difference between the two groups was statistically significant(χ^(2)=5.192,P=0.023).In PVT group the preoperative Child-Pugh score,the model of end-stage liver disease(MELD)score and serum sodium model of end-stage liver disease(MELD-Na+)score were(8.1±1.9)points,(9.2±8.0)points and(9.2±8.0)points respectively,which in non-PVT group were(7.4±1.9)points,(7.7±5.8)points and(7.7±5.8)points respectively,the differences between the two groups were statistically significant(all P<0.05).The incidence of overt hepatic encephalopathy in PVT group was 33.3%(25/75),which was strikingly higher than 19.5%(23/118)in non-PVT group,the difference between the two groups was statistically significant(P=0.030).No statistically significant differences in postoperative survival rate,rebleeding rate and stent dysfunction rate existed between the two groups(all P>0.05).Conclusion For the treatment of cirrhotic patients with PVT complicated by gastrointestinal bleeding,TIPS is clinically safe and effective.In cirrhotic patients with PVT,the wor

关 键 词：肝硬化 门静脉血栓形成 消化道出血 经颈静脉肝内门体分流术 

分 类 号：R657.31[医药卫生—外科学]