经颈静脉肝内门体静脉分流术对肝硬化门静脉高压症患者门静脉直径及远期疗效的影响

肝脏 ›› 2024, Vol. 29 ›› Issue (5): 516-520.

经颈静脉肝内门体静脉分流术对肝硬化门静脉高压症患者门静脉直径及远期疗效的影响

马志刚, 刘丽丽, 王旭, 冯鹏丽, 杨帆, 杨永宾

072750 河北保定市第二中心医院导管介入室(马志刚),消化内科(王旭), CT室(冯鹏丽),药剂科(杨帆),心血管外科(杨永宾);073000 定州市人民医院健康体检科(刘丽丽);050057 石家庄河北省人民医院心血管外科(杨永宾)

收稿日期:2023-05-28 出版日期:2024-05-31 发布日期:2024-08-28
基金资助:
2022年度河北省医学适用技术跟踪项目(GZ2022005)

The impacts of transjugular intrahepatic portosystemic shunt on the portal vein diameter and long-term outcome of liver cirrhotic patients with portal hypertension

MA Zhi-gang¹, LIU Li-li², WANG Xu³, FENG Peng-li⁴, YANG Fan⁵, YANG Yong-bin⁶

1. Catheter Intervention Room, Baoding Second Central Hospital, Hebei 072750, China;
2. Department of Health Examination, Dingzhou People′s Hospital, Hebei 073000, China;
3. Department of Gastroenterology, Baoding Second Central Hospital, Hebei 072750, China;
4. CT Room, Baoding Second Central Hospital, Hebei 072750, China;
5. Department of Pharmacy, Baoding Second Central Hospital, Hebei 072750, China;
6. Department of Cardiovascular Surgery, Hebei Provincial People′s Hospital, Shijiazhuangi 050051, China

Received:2023-05-28 Online:2024-05-31 Published:2024-08-28

摘要/Abstract

摘要： 目的探究经颈静脉肝内门体静脉分流术(TIPS)对肝硬化门静脉高压症(PHT)患者门静脉直径(PVD)及远期疗效的影响。方法选择2017年1月—2020年1月保定市第二中心医院收治的100例肝硬化PHT患者,利用随机数字表法分为对照组(50例,采用贲门周围血管离断术治疗)与研究组(50例,采用TIPS治疗),收集患者的临床资料并比较两组患者的肝脏血流动力学、肝功能及远期疗效。结果术前1 d,两组肝硬化PHT患者的PVD、门静脉血流量(PVF)、脾静脉内径(SVD)、脾静脉血流量(SVF)、门静脉流速(PVV)、脾静脉流速(SVV)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)及总胆红素(TBil)比较差异均无统计学意义(P>0.05);术后7 d,PVD [(1.15±0.22) cm vs (1.53±0.32) cm]、PVF[(774.45±101.28) mL vs (845.33±120.39) mL]、SVD[(1.17±0.21) cm vs (1.32±0.27) cm]、SVF[(304.47±63.38) mL vs (400.01±74.12) mL]、ALT[(38.45±8.61) U/L vs (50.26±10.05) U/L]、AST[(39.18±8.97) U/L vs (48.51±10.13) U/L]、TBil[(28.19±6.08) μmol/L vs (39.53±8.96) μmol/L]均降低(P<0.05),PVV[(45.69±9.98) cm/s vs (30.08±6.57) cm/s]及SVV[(24.76±6.02) cm/s vs (18.96±4.04) cm/s]均升高(P<0.05),且上述指标研究组改善更为明显(P<0.05)。两组肝硬化PHT患者的存活率随着术后时间的增加而降低,术后3年研究组的存活率明显高于对照组(P<0.05),并且,术后3年研究组的不良事件总发生率低于对照组,但两组之间差异无统计学意义(P>0.05)。结论 TIPS治疗肝硬化PHT效果确切,可明显改善肝硬化PHT患者肝脏血流动力学及肝功能,对患者的远期疗效好。

关键词: 经颈静脉肝内门体静脉分流术, 贲门周围血管离断术, 肝硬化门静脉高压症, 门静脉直径, 远期疗效

Abstract: Objective To investigate the impacts of transjugular intrahepatic portosystemic shunt (TIPS) on portal vein diameter (PVD) and long-term outcome of patients with liver cirrhosis and portal hypertension (PHT). Methods A total of 100 patients with liver cirrhosis and PHT admitted from January 2017 to January 2020 were randomly grouped into a control group (50 cases, treated with pericardial revascularization) and a study group (50 cases, treated with TIPS) using a random number table method. The clinical data of all patients were collected and the liver hemodynamics, liver function, and long-term efficacy of the treatments in both groups of patients were compared. Results One day before surgery, there were no obvious differences in PVD, portal venous blood flow (PVF), splenic venous inner diameter (SVD), splenic venous blood flow (SVF), portal venous flow velocity (PVV), splenic venous flow velocity (SVV), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) between the two groups (P>0.05). At 7d after surgery, The PVD [(1.15±0.22) cm vs (1.53±0.32) cm], PVF [(774.45±101.28) mL vs (845.33±120.39) mL], SVD [(1.17±0.21) cm vs (1.32±0.27) cm], SVF [(304.47±63.38) mL vs (400.01±74.12) mL], ALT [(38.45±8.61) U/L vs (50.26±10.05) U/L], AST [(39.18±8.97) U/L vs (48.51±10.13) U/L], and TBil [(28.19±6.08) μmol/L vs (39.53±8.96) μmol/L] were decreased and improved more in the study group when compared with those in the control group (P<0.05), whereas PVV [(45.69±9.98) cm/s vs (30.08±6.57) cm/s] and SVV [(24.76±6.02) cm/s vs (18.96±4.04) cm/s] were increased (P<0.05). The survival rate of PHT patients with liver cirrhosis in both groups decreased with the increase of postoperative time, and the survival rate in the study group was obviously higher than that in the control group in 3 years after surgery (P<0.05), moreover, the total incidence of adverse events in the study group was lower than that in the control group in three years after surgery, however, there was no obvious difference between the two groups (P>0.05). Conclusion TIPS is effective in the treatment of PHT in patients with liver cirrhosis, and may obviously improve liver hemodynamics and liver function in patients with liver cirrhosis and PHT, with a good long-term effect on the patients.

Key words: Transjugular intrahepatic portosystemic shunt, Pericardial vascular disconnection, Liver cirrhosis with portal hypertension, Diameter of portal vein, Long term efficacy

马志刚, 刘丽丽, 王旭, 冯鹏丽, 杨帆, 杨永宾. 经颈静脉肝内门体静脉分流术对肝硬化门静脉高压症患者门静脉直径及远期疗效的影响[J]. 肝脏, 2024, 29(5): 516-520.

MA Zhi-gang, LIU Li-li, WANG Xu, FENG Peng-li, YANG Fan, YANG Yong-bin. The impacts of transjugular intrahepatic portosystemic shunt on the portal vein diameter and long-term outcome of liver cirrhotic patients with portal hypertension[J]. Chinese Hepatolgy, 2024, 29(5): 516-520.

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