不同支架类型下行经颈静脉肝内门体分流术治疗门静脉高压上消化道出血的临床疗效比较  

Clinical efficacy comparison of transjugular intrahepatic portal shunt for portal hypertension under different stent types

作　　者：吴广迎 秦鹏[1] 李树森[1] 张延娟 卢艳丽 Wu Guangying;Qin Peng;Li Shusen;Zhang Yanjuan;Lu Yanli(Department of Intervention Vascular Surgery,the Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China;ICU,the Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China;Department of Emergency,the Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China)

机构地区：[1]邢台医学高等专科学校第二附属医院介入血管外科,河北邢台054000 [2]邢台医学高等专科学校第二附属医院ICU,河北邢台054000 [3]邢台医学高等专科学校第二附属医院急诊科,河北邢台054000

出　　处：《血管与腔内血管外科杂志》2025年第2期245-250,共6页Journal of Vascular and Endovascular Surgery

基　　金：邢台市重点研发计划项目(2022ZC215)。

摘　　要：目的探讨不同支架类型下行经颈静脉肝内门体分流术治疗门静脉高压上消化道出血的临床疗效。方法收集2022年6月至2024年6月邢台医学高等专科学校第二附属医院收治的120例门静脉高压上消化道出血患者的临床资料,根据支架类型的不同将其分为A组(裸支架)、B组(覆膜支架)和联合组(裸支架联合覆膜支架),各40例。术前、术后10个月,测量所有患者的门静脉、脾脏血流动力学情况,检测天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBIL)、白蛋白(Alb)、CD3^(+)、CD4^(+)、CD8^(+)、血小板计数(PLT)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平。比较两组患者的临床疗效和术后并发症发生率。结果与A组、B组患者相比,联合组患者的脾静脉淤血指数、门静脉压力、门静脉内径、脾脏长径、脾脏厚度、AST、ALT、TBIL、PLT、CD8^(+)、TNF-α和IL-6水平均有所降低,门静脉流速、Alb、CD3^(+)和CD4^(+)水平均有所升高,差异均有统计学意义(P﹤0.05);与A组、B组患者相比,联合组患者的临床总有效率最高,术后并发症发生率最低,差异均有统计学意义(P﹤0.05)。结论对于经颈静脉肝内门体分流术治疗的门静脉高压上消化道出血患者,与单一使用裸支架和覆膜支架相比,两者联合使用能够显著改善门静脉血流动力学、脾脏血流动力学及形态水平,改善肝功能,提高免疫功能,减轻炎症反应,整体治疗效果较为显著。Objective To explore the clinical efficacy of transjugular intrahepatic portal shunt for portal hypertension under different stent types.Method The clinical data of 120 patients with upper gastrointestinal bleeding from portal hypertension admitted to the Second Affiliated Hospital of Xingtai Medical College from June 2022 to June 2024 were collected.According to the different types of stents,they were divided into group A(bare stent),group B(covered stent),and combined group(bare stent combined with covered stent),with 40 cases in each group.The portal and spleen hemodynamics of all patients were measured before and 10 months after surgery;the levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL),CD3^(+),CD4^(+),CD8^(+),platelet count(PLT),tumor necrosis factorα(TNF-α),and interleukin-6(IL-6)were measured.The clinical efficacy and incidence of postoperative complications between two groups of patients were compared.Result Compared with patients in group A and group B,the splenic vein congestion index,portal vein pressure,portal vein diameter,spleen length and diameter,spleen thickness,AST level,ALT level,TBIL level,PLT,CD8^(+)level,TNF-αlevel,IL-6 level were decreased in the combined group,while portal vein velocity,Alb level,CD3^(+)level,and CD4^(+)level were increased in the combined group,the differences were statistically significant(P<0.05).Compared with patients in groups A and B,the combined group had the highest clinical total effective rate and the lowest incidence of postoperative complications,the differences were statistically significant(P<0.05).Conclusion For patients with portal hypertension and upper gastrointestinal bleeding treated with transjugular intrahepatic portal shunt,compared with the single use of bare stent and coated stent,the combination of the two can significantly improve the portal vein hemodynamics,spleen hemodynamics and morphology level,improve liver function,improve immune function and reduce inflammatory response,and the overall tre

关 键 词：肝硬化门静脉高压 经颈静脉肝内门体分流术 上消化道出血 裸支架 覆膜支架 

分 类 号：R543[医药卫生—心血管疾病]