TIPS治疗土三七致肝窦阻塞综合征中长期生存分析  

Transjugular intrahepatic portosystemic shunt for hepatic sinusoidal obstruction syndrome caused by Gynura segetum:analysis of the mid-to-long-term survival

作　　者：吴昱霖 侯昌龙 熊柏柱 周磊[2] 费一鹏 周伊然 WU Yulin;HOU Changlong;XIONG Baizhu;ZHOU Lei;FEI Yipeng;ZHOU Yiran(Graduate School of Bengbu Medical University,Bengbu,AnhuiProvince 233030,China)

机构地区：[1]蚌埠医科大学研究生院,安徽蚌埠233030 [2]中国科学技术大学附属第一医院(安徽省立医院)介入放射科 [3]皖南医学院研究生院

出　　处：《介入放射学杂志》2025年第2期180-185,共6页Journal of Interventional Radiology

基　　金：安徽省教育厅重大课题项目(2023AH040399);国家癌症中心攀登基金临床研究课题项目(NCC201912B01)。

摘　　要：目的探讨经颈静脉肝内门体分流术(TIPS)在土三七致肝窦阻塞综合征(hepatic sinusoidal obstruction syndrome,HSOS)患者中的应用及中长期生存情况。方法回顾性分析2016年4月至2022年9月中国科学技术大学附属第一医院收治的44例行TIPS治疗的土三七致HSOS患者临床资料,比较术前和术后肝肾功能指标、腹水缓解情况及门静脉压力等,超声检查观察支架血流通畅情况及腹水深度,同时观察术后并发症发生情况。使用Kaplan-Meier曲线计算累积生存率,以评估患者生存情况。结果44例土三七致HSOS患者按病情严重程度分为轻度5例,中度13例,重度19例,极重度7例。所有患者TIPS手术成功率为100%,均未发生严重并发症。TIPS治疗后肝性脑病发生率为20.5%(9/44)。门静脉压力由术前(42.00±0.91)cm H2O降至术后(18.27±0.67)cm H2O,差异有统计学意义(P<0.001)。术后血肌酐、转氨酶、总胆红素及Child-Pugh评分与术前比较降低,白蛋白与术前比较升高,差异有统计学意义(均P<0.05)。术后1年、5年累积生存率分别为90.9%、88.6%。不同严重程度患者1、3、6、12个月生存率:轻度患者均为100.0%,中度患者分别为100.0%、100.0%、92.3%、92.3%,重度患者均为94.7%,极重度患者分别为85.7%、71.4%、71.4%、71.4%。结论TIPS是治疗土三七致HSOS有效方法,可显著改善患者腹水情况,总体并发症发生率低,中长期生存率高。Objective To explore the effect of transjugular intrahepatic portosystemic shunt(TIPS)in treating patients with hepatic sinusoidal obstruction syndrome(HSOS)caused by gynura segetum,and to analyze the mid-to-long-term survival.Methods The clinical data of 44 patients with HSOS caused by gynura segetum,who were admitted to the First Affiliated Hospital of University of Science and Technology of China from April 2016 to September 2022 to receive TIPS treatment,were retrospectively analyzed.The preoperative and postoperative liver and kidney functions,ascites,and portal vein pressure were compared.Ultrasonography examination was performed to check the patency of stent and the thickness of ascites,the postoperative complications were recorded.Kaplan-Meier curve was used to calculate the cumulative survival so as to evaluate the survival of patients.Results Based on the severity of the illness,the 44 patients were divided into mild group(n=5),moderate group(n=13),severe group(n=19)and very severe group(n=7).Successful TIPS operation was achieved in all the patients,with a surgical success rate of 100%.No serious complications occurred.After TIPS,the incidence of hepatic encephalopathy(HE)was 20.5%(9/44).The portal pressure decreased from preoperative(42.00±0.91)cm H_2O to postoperative(18.27±0.67)cm H_2O,the difference was statistically significant(P<0.001).The postoperative blood creatinine,aminotransferase,total bilirubin and Child-Pugh score were decreased when compared with their preoperative values,while the albumin level was increased when compared with its preoperative value,the differences were statistically significant(all P<0.05).The postoperative one-year and 5-year cumulative survival rates were 90.9%and 88.6%respectively.The 1-,3-,6-and 12-month survival rates in mild group were all 100%,in moderate group were 100.0%,100.0%,92.3%and 92.3%respectively,in severe group were 94.7%,94.7%,94.7%and 89.5%respectively,and in very severe group were 85.7%,71.4%,71.4%and 71.4%respectively.Conclusion For the treatme

关 键 词：肝窦阻塞综合征 经颈静脉肝内门体分流术 土三七 生存率 

分 类 号：R575[医药卫生—消化系统]