目的观察经颈静脉肝内门腔分流术(TIPS)后患者肝功能的变化情况,以及TIPS术后肝损伤的危险因素分析。方法收集2017年4月至2019年8月南方医科大学南方医院收治的肝硬化合并门静脉高压患者198例,均成功实施TIPS,随访术后1、3、6、12、18...目的观察经颈静脉肝内门腔分流术(TIPS)后患者肝功能的变化情况,以及TIPS术后肝损伤的危险因素分析。方法收集2017年4月至2019年8月南方医科大学南方医院收治的肝硬化合并门静脉高压患者198例,均成功实施TIPS,随访术后1、3、6、12、18和24个月的终末期肝病模型(MELD)评分以及Child-Pugh评分。采用非条件Logistic回归模型筛选出术后重度肝损伤的独立危险因素,绘制ROC曲线图形,计算AUC以判断各危险因素的预测效能。结果MELD评分从术后1个月开始显著升高(13.8±3.9 vs 11.0±3.4;P<0.001),之后逐渐降低至术后1年又缓慢回升,但始终明显高于术前基线水平。Child-Pugh评分从术后6个月开始逐渐降低,在术后1年降至最低值(6.6±1.3 vs 6.9±1.4;P=0.027),之后逐渐回升至术前基线水平。原发性肝癌、术前MELD评分以及术前Child-Pugh评分是TIPS术后1年重度肝损伤的独立危险因素(OR=4.452,P=0.012;OR=1.320,P=0.001;OR=1.509,P=0.033),术前MELD评分和Child-Pugh评分的cut-off值分别为13.5、7.5。结论TIPS因机械性损伤和肝内门腔分流,导致术后肝功能不同程度受损。原发性肝癌、术前MELD评分以及术前Child-Pugh评分是TIPS术后1年重度肝损伤的独立危险因素。展开更多
Objective:: To investigate the treatment and causes of death about severe blunt liver injury. Methods: The data of 133 patients with severe blunt liver injury (Grade Ⅲ to Grade Ⅴ) were analyzed retrospectively. All ...Objective:: To investigate the treatment and causes of death about severe blunt liver injury. Methods: The data of 133 patients with severe blunt liver injury (Grade Ⅲ to Grade Ⅴ) were analyzed retrospectively. All the patients except 2 underwent operations. Different types of surgical procedures were adopted according to the severity of liver injury. Results: Operations were the major method to treat hepatic injury. The total mortality rate was 21.0 % in this study. The mortality rates of Grade Ⅲ, Grade Ⅳ and Grade Ⅴ of liver injuries were 11.3 %, 24.4 % and 69.2 %, respectively. Conclusions: Packing treatment plays an important role in the treatment of hepatic injury. The mortality rate is related closely to the severity of hepatic injury, multiple trauma, shock and disturbance of blood coagulation.展开更多
文摘目的观察经颈静脉肝内门腔分流术(TIPS)后患者肝功能的变化情况,以及TIPS术后肝损伤的危险因素分析。方法收集2017年4月至2019年8月南方医科大学南方医院收治的肝硬化合并门静脉高压患者198例,均成功实施TIPS,随访术后1、3、6、12、18和24个月的终末期肝病模型(MELD)评分以及Child-Pugh评分。采用非条件Logistic回归模型筛选出术后重度肝损伤的独立危险因素,绘制ROC曲线图形,计算AUC以判断各危险因素的预测效能。结果MELD评分从术后1个月开始显著升高(13.8±3.9 vs 11.0±3.4;P<0.001),之后逐渐降低至术后1年又缓慢回升,但始终明显高于术前基线水平。Child-Pugh评分从术后6个月开始逐渐降低,在术后1年降至最低值(6.6±1.3 vs 6.9±1.4;P=0.027),之后逐渐回升至术前基线水平。原发性肝癌、术前MELD评分以及术前Child-Pugh评分是TIPS术后1年重度肝损伤的独立危险因素(OR=4.452,P=0.012;OR=1.320,P=0.001;OR=1.509,P=0.033),术前MELD评分和Child-Pugh评分的cut-off值分别为13.5、7.5。结论TIPS因机械性损伤和肝内门腔分流,导致术后肝功能不同程度受损。原发性肝癌、术前MELD评分以及术前Child-Pugh评分是TIPS术后1年重度肝损伤的独立危险因素。
文摘Objective:: To investigate the treatment and causes of death about severe blunt liver injury. Methods: The data of 133 patients with severe blunt liver injury (Grade Ⅲ to Grade Ⅴ) were analyzed retrospectively. All the patients except 2 underwent operations. Different types of surgical procedures were adopted according to the severity of liver injury. Results: Operations were the major method to treat hepatic injury. The total mortality rate was 21.0 % in this study. The mortality rates of Grade Ⅲ, Grade Ⅳ and Grade Ⅴ of liver injuries were 11.3 %, 24.4 % and 69.2 %, respectively. Conclusions: Packing treatment plays an important role in the treatment of hepatic injury. The mortality rate is related closely to the severity of hepatic injury, multiple trauma, shock and disturbance of blood coagulation.
