目的探讨常规CT三期类灌注参数动脉增强分数(AEF)值在肝硬化门静脉高压(PHT)行TIPS术后疗效评价中的应用价值。方法回顾性分析行TIPS术的30例PHT患者术前1周内、术后4~6周内的常规CT三期类灌注扫描图像。按照术后患者临床表现,分为治疗...目的探讨常规CT三期类灌注参数动脉增强分数(AEF)值在肝硬化门静脉高压(PHT)行TIPS术后疗效评价中的应用价值。方法回顾性分析行TIPS术的30例PHT患者术前1周内、术后4~6周内的常规CT三期类灌注扫描图像。按照术后患者临床表现,分为治疗有效组和无效组。应用软件计算AEF值,AEF值为(动脉期CT值-平扫期CT值)/(门静脉期CT值-平扫期CT值),将结果与术后患者临床表现相结合并进行统计学分析。结果术后较术前AEF值明显增高(0.521±0.093 vs 0.446±0.057,Z=-4.214,P<0.05);有效组25例(出血治疗有效23例,腹腔积液治疗有效2例),无效组5例(出血治疗无效2例,腹腔积液治疗无效3例),有效组较无效组AEF值明显增高(0.533±0.098 vs 0.463±0.021,Z=-2.198,P<0.05),差异有统计学意义。以术后AEF值0.501为临界值预测TIPS术后短期内疗效,敏感性和特异性分别为60%和100%,曲线下面积为0.816(P<0.001)。结论常规CT三期类灌注扫描参数AEF值可能能定量评估肝硬化门静脉高压行TIPS术后短期内的疗效。展开更多
Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications ...Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt.</span><b> </b><span style="font-family:Verdana;">Male, elderly, and ex-alcoholic, diagnosed with liver cirrho</span><span style="font-family:Verdana;">sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital</span> <span style="font-family:Verdana;">after 24 hours with agitation and mental confusion. He had a bowel move</span><span style="font-family:Verdana;">ment stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome.</span><b> </b><span style="font-family:Verdana;">Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.展开更多
文摘目的探讨常规CT三期类灌注参数动脉增强分数(AEF)值在肝硬化门静脉高压(PHT)行TIPS术后疗效评价中的应用价值。方法回顾性分析行TIPS术的30例PHT患者术前1周内、术后4~6周内的常规CT三期类灌注扫描图像。按照术后患者临床表现,分为治疗有效组和无效组。应用软件计算AEF值,AEF值为(动脉期CT值-平扫期CT值)/(门静脉期CT值-平扫期CT值),将结果与术后患者临床表现相结合并进行统计学分析。结果术后较术前AEF值明显增高(0.521±0.093 vs 0.446±0.057,Z=-4.214,P<0.05);有效组25例(出血治疗有效23例,腹腔积液治疗有效2例),无效组5例(出血治疗无效2例,腹腔积液治疗无效3例),有效组较无效组AEF值明显增高(0.533±0.098 vs 0.463±0.021,Z=-2.198,P<0.05),差异有统计学意义。以术后AEF值0.501为临界值预测TIPS术后短期内疗效,敏感性和特异性分别为60%和100%,曲线下面积为0.816(P<0.001)。结论常规CT三期类灌注扫描参数AEF值可能能定量评估肝硬化门静脉高压行TIPS术后短期内的疗效。
文摘Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt.</span><b> </b><span style="font-family:Verdana;">Male, elderly, and ex-alcoholic, diagnosed with liver cirrho</span><span style="font-family:Verdana;">sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital</span> <span style="font-family:Verdana;">after 24 hours with agitation and mental confusion. He had a bowel move</span><span style="font-family:Verdana;">ment stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome.</span><b> </b><span style="font-family:Verdana;">Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.
文摘目的：探讨经颈静脉肝内门体分流术（transjugular intrahepatic portosystemic shunt,TIPS）治疗肝硬化顽固性腹水的临床疗效及影响预后因素。方法：23例肝硬化顽固性腹水患者术后随访1~26月（平均9.7月）,观察患者腹水缓解情况（腹水量）、临床血清学指标（血小板计数、白蛋白、总胆红素、凝血酶原时间、肌酐等）、生存率等。采用配对t检验、非参数检验分析术前术后临床血清学指标的变化情况,Kaplan-Merier方法计算生存率,术前危险因素预测3个月腹水疗效采用logistic回归分析,术前危险因素对术后生存情况的影响采用COX多因素回归模型分析,受试者工作曲线（receiver operating characteristic,ROC）及曲线下面积（area under the curve,AUC）判断最佳预测界值。结果：术后1年的各个随访期患者的腹水与术前比较明显改善,82.6%的患者术后1月腹水得到有效控制,52.4%患者在术后3月仅存少量腹水,术后6月在访的所有患者腹水均为少量。术后1周肝功能存在短期损害凝血酶原时间延长,中值（最小值,最大值）=19.6（14.0,28.7）,Z=-2.419,P=0.016;Child-Pugh评分增加,x±s=9.87±1.71,t=-2.714,P=0.013;总胆红素升高,Z=-3.711,P=0.000,中值（最小值,最大值）=37.0（13.2,204.3）,之后逐渐恢复。术后3个月、6个月及1年的累积生存率为95.5%、85.9%、78.1%。COX回归多因素分析显示血钠（P=0.027,HR=0.677,95%CI=0.479~0.956）、总胆红素（P=0.007,HR=1.049,95%CI=1.012~1.086）是影响预后的独立危险因素。运用ROC及AUC分析提示总胆红素AUC为0.676,95%CI为0.335~1.000,总胆红素37μmol/L（敏感性66.7%,特异性94.1%）为最佳预测界值。Kaplan-Merier生存率分析显示总胆红素≥37μmol/L及总胆红素〈37μmol/L时的1年生存率分别为25%、92.3%。结论：TIPS是治疗肝硬化顽固性腹水的有效方案,术后存在短期的肝功能损害;总胆红素≥37μmol/L是预测肝硬化顽固性腹水患�
