摘要
目的肝硬化患者自发性门体分流发生率及治疗后预后情况分析。方法选择2017年6月—2018年11月于我院就诊的肝硬化合并门静脉高压患者220例,均采用TIPS手术降门脉高压,同时对术中发现自发性门体分流患者采用弹簧钢圈、血管硬化剂或Amplatzer封堵器进行封堵。统计所有患者中自发性门体分流发生率,对所有患者进行为期1年术后随访,记录患者死亡情况、术后并发症发生情况。结果 220例肝硬化门静脉高压患者中有85例38.64%合并自发性门体分流。合并自发性门体分流患者术后1年内肝性脑病累积发生率为32.41%、腹水为36.47%、上消化道出血为23.53%;支架畅通率在术后1年内降至78.82%。合并与未合并自发性分流患者术后1年内死亡率比较无明显差异(P>0.05)。合并自发性门体分流患者术后1年内肝性脑病累积发生率32.41%与未合并自发性门体分流患者21.48%比较无显著差异(P>0.05)。有肝性脑病病史是TIPS手术后1年内发生肝性脑病的独立危险因素(P<0.05)。结论本研究中肝硬化门静脉高压患者自发性门体分流发生率为38.64%,在经TIPS联合封堵治疗后可达到封堵目的并有效降低患者门静脉高压,术后1年内肝性脑病累积发生率与患者术前有肝性脑病病史有关。
Objective To investigate the incidence and prognosis of spontaneous portosystemic shunt in patients with cirrhosis.Methods A total of 220 patients with cirrhosis complicated with portal hypertension admitted to our hospital from June 2017 to November 2018 were selected.All patients received the transjugular intrahepatic portosystemic shunt(TIPS),and patients with spontaneous portosystemic shunt received the coil,angiosclerotic agent or Amplatzer occlude.The incidence rate of spontaneous portosystemic shunt was recorded.The death and postoperative complications were also recorded during the postoperative 1-year follow-up.Results The incidence rate of spontaneous portosystemic shunt was38.64%(85/220).In patients with spontaneous portosystemic shunt,the postoperative 1-year cumulative incidence rates of hepatic encephalopathy,ascites and upper gastrointestinal hemorrhage were 32.41%,36.47%and 23.53%,respectively.The stent patency rate decreased to 78.82%1 year after operation.The postoperative 1-year mortality had no significant difference between patients with and without spontaneous portosystemic shunt(P>0.05).The postoperative 1-year cumulative incidence of hepatic encephalopathy of patients with spontaneous portosystemic shunt had no difference with that of patients without spontaneous portosystemic shunt(32.41%vs 21.48%,P>0.05).The history of hepatic encephalopathy was an independent risk factor for hepatic encephalopathy within 1 year after TIPS(P<0.05).Conclusion In this study,the incidence of spontaneous portosystemic shunt in cirrhotic patients with portal hypertension was38.64%.TIPS combined with occlusion can effectively reduce portal pressure.Moreover,the incidence of hepatic encephalopathy within 1 year after operation is related to the history of hepatic encephalopathy before operation.
作者
王涛
李木松
韩秋然
李彩虹
孙静伟
WANG Tao;LI Mu-song;HAN Qiu-ran;LI Cai-hong;SUN Jing-wei(Department of Medical Services Section,Baoding Infectious Hospital,Hubei 071000,China;Hepatic Department,Baoding Infectious Hospital,Hubei 071000,China;Physical Examination Department,the first Hospital of Baoding,Hubei 071000,China;Health Management Center,Baoding Infectious Hospital,Hubei 071000,China)
出处
《肝脏》
2020年第9期948-951,共4页
Chinese Hepatology
关键词
肝硬化
门静脉高压
自发性门体分流
预后
Cirrhosis
Portal hypertension
Spontaneous portosystemic shunt
Prognosis
