Association between portal vein pressure drop gradient after transjugular intrahepatic portosystemic shunt and clinical prognosis
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摘要: 目的探讨经颈静脉肝内门体分流术(TIPS)治疗肝硬化门静脉高压症患者的门静脉压力下降梯度与临床预后的关系,总结理想的门静脉压力降低范围。方法收集2013年11月-2015年12月于第三军医大学新桥医院消化科行TIPS的患者58例,所有患者均行TIPS和胃冠状静脉及胃短静脉栓塞术,监测门静脉压力梯度变化区间值,随访时间3 d24个月,分析门静脉压力降低梯度与术后肝功能、脾功能、再出血率、并发肝性脑病及门静脉高压性胃肠疾病的关系。手术前后各指标的比较采用配对t检验。结果术后3 d患者肝功能明显下降。术后2个月,TBil水平较术前明显升高,差异有统计学意义[(49.81±27.82)μmol/L vs(31.64±17.67)μmol/L,t=5.372,P<0.001]。术后6个月,RBC、PLT水平变化较术前不明显,但WBC有所下降,且差异具有统计学意义[(3.79±1.37)×109/L vs(4.57±2.24)×109/L,t=2.835,P=0.006]。患者术前门静脉压力为(30.62±3.56)mm Hg...
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关键词:
- 肝硬化 /
- 食管和胃静脉曲张 /
- 门静脉压 /
- 门体分流术,经颈静脉肝内
Abstract: Objective To investigate the association between portal vein pressure drop gradient in patients with cirrhotic portal hypertension treated by transjugular intrahepatic portosystemic shunt( TIPS) and clinical prognosis,as well as the ideal range of portal vein pressure drop. Methods A total of 58 patients who underwent TIPS in Xinqiao Hospital of Third Military Medical University from November 2013 to December 2015 were enrolled. All the patients underwent TIPS and embolization of the gastric coronary vein and the short gastric veins,and the change intervals of portal vein pressure gradient were monitored. The follow- up time ranged from 3 days to 2 years,and the association of portal vein pressure drop gradient with postoperative liver function,splenic function,rebleeding rate,hepatic encephalopathy,and portal hypertensive gastrointestinal diseases was analyzed. The paired t- test was used for comparison of parameters before and after treatment. Results The patients had a significant reduction in liver function on day 3 after surgery. At 2 month after surgery,the levels of TBil was rised and had significant changes[( 49. 81 ± 27. 82) μmol/L vs( 31. 64 ± 17. 67) μmol/L,t = 5. 372,P < 0. 001]. At 6 months after surgery,red blood cell count and platelet count had no significant changes,but,white blood cell count was reduced[( 3. 79 ± 1. 37) ×10~9/L vs( 4. 57 ±2. 24) ×10~9/L,t = 2. 835,P = 0. 006]. There was a 23% reduction in portal vein pressure after surgery( from 30. 62 ± 3. 56 mm Hg before surgery to 21. 21 ± 2. 90 mm Hg after surgery,t = 23. 318,P < 0. 001). All the patients had varying degrees of relief of gastrointestinal symptoms associated with portal vein hypertension,such as abdominal distension,poor appetite,and diarrhea. Of all patients,none experienced in- stent restenosis or occlusion and 13 experienced hepatic encephalopathy after surgery,which tended to occur at the time when postoperative portal vein pressure was reduced to 14. 7- 25. 7 mm Hg,i. e.,a 36%- 40% reduction in portal vein pressure. The results of splenic venography performed immediately after surgery showed that varicose veins almost disappeared and that there were no collateral varices. Gastroscopy was performed again within 1 month after surgery and 5 patients had no significant changes in esophageal varices. The other patients were followed up for 2 years,and the severity of esophageal and gastric varices gradually changed from severe varices with red color sign to moderate and mild varices and even disappeared. The proportion of patients with mild and disappeared varices increased from 22% on day 3after surgery to 52% in the second year after surgery. No patients experienced rebleeding within 1 month after surgery. Six patients each experienced rebleeding at 2,6,10,14,16,and 24 months after surgery,and in one patient,duodenal bulbar ulcer and bleeding was not excluded; the other 5 patients experienced gastric variceal bleeding again,with a median portal vein pressure of 36. 46 mm Hg before surgery and 24. 8 mm Hg after surgery,with a 32% reduction in portal vein pressure. Conclusion TIPS has a good clinical effect in hemostasis and prevention of rebleeding in patients with cirrhotic portal hypertension and can control the portal vein pressure below 21. 21 ± 2. 90 mm Hg,and the degree of reduction in portal vein pressure is below 36%- 40%. It can reduce the incidence of postoperative rebleeding and avoid the development of hepatic encephalopathy. TIPS can cause liver impairment within a short period of time after surgery,and liver function can return to normal within 1- 6 months after surgery,but splenic function does not recover significantly. -
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