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限流支架治疗经颈静脉肝内门体分流术后复发性或持续性显性肝性脑病的效果和安全性

何创业 陈辉 吕勇 夏冬东 余天垒 袁旭龙 李凯 王钲钰 牛静 白苇 郭文刚 帖君 殷占新 韩国宏

杨大银, 杜毅超, 谭鹏, 陈浩, 钱保林, 王安康, 黄诗尧, 付文广, 夏先明. Hic-5基因敲除对NF-κB/p65表达及CCl4诱导的肝纤维化小鼠模型的影响[J]. 临床肝胆病杂志, 2019, 35(11): 2483-2488. DOI: 10.3969/j.issn.1001-5256.2019.11.019.
引用本文: 杨大银, 杜毅超, 谭鹏, 陈浩, 钱保林, 王安康, 黄诗尧, 付文广, 夏先明. Hic-5基因敲除对NF-κB/p65表达及CCl4诱导的肝纤维化小鼠模型的影响[J]. 临床肝胆病杂志, 2019, 35(11): 2483-2488. DOI: 10.3969/j.issn.1001-5256.2019.11.019.
Yang DaYin, Du YiChao, Tan Peng, Chen Hao, Qian BaoLin, Wang AnKang, Huang ShiYao, Fu WenGuang, Xia XianMing. Effect of Hic-5 gene knockout on NF-κB/p65 expression and CCl4-induced liver fibrosis degree in mice[J]. J Clin Hepatol, 2019, 35(11): 2483-2488. DOI: 10.3969/j.issn.1001-5256.2019.11.019.
Citation: Yang DaYin, Du YiChao, Tan Peng, Chen Hao, Qian BaoLin, Wang AnKang, Huang ShiYao, Fu WenGuang, Xia XianMing. Effect of Hic-5 gene knockout on NF-κB/p65 expression and CCl4-induced liver fibrosis degree in mice[J]. J Clin Hepatol, 2019, 35(11): 2483-2488. DOI: 10.3969/j.issn.1001-5256.2019.11.019.

限流支架治疗经颈静脉肝内门体分流术后复发性或持续性显性肝性脑病的效果和安全性

DOI: 10.3969/j.issn.1001-5256.2019.08.014
基金项目: 

陕西省重点研发计划项目(S2018-YF-YBSF-0554); 

详细信息
  • 中图分类号: R575.3

Safety and efficacy of flow-reducing stent in treatment of recurrent or persistent hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Research funding: 

 

  • 摘要:

    目的分析限流支架治疗经颈静脉肝内门体分流术(TIPS)后复发性或持续性肝性脑病的效果和安全性。方法选取空军军医大学第一附属医院2013年1月-2018年8月TIPS术后明确诊断为持续性或复发性显性肝性脑病的患者11例。限流支架置入前后选用客观量表对肝性脑病患者进行准确评估。限流支架应尽量选择同类型和合适长度的金属覆膜支架,术中术后常规门静脉造影并测门静脉压力梯度。主要观察终点为肝性脑病的变化情况。采用配对t检验分析手术前后各项检测指标的变化。结果11例患者均成功置入限流支架,限流支架置入后1周内8例患者肝性脑病消失,2例患者降为1级,其中1例患者因肝硬化严重并发肝衰竭,肝性脑病改善不明显。直径4 mm限流支架2例,5 mm 8例,6 mm 1例,限流术后门静脉压力梯度升高[(6. 09±0. 70)mm Hg vs (15. 36±2. 94) mm Hg,t=2. 53,P=0. 003 8]。限流术后数字编码测试所需的时间较术前有显著下降[(269±80) s vs(464±90) s,t=2. 94,P=0. 001]。术后1个月患者Alb改善显著(t=1. 75,P=0. 01...

     

  • [1] CHEN Q, ZHANG Y, YUE ZD, et al. Clinical efficacy of transjugular intrahepatic portosystemic shunting for recurrent portal hypertension after liver transplantation[J]. Chin J Dig Surg, 2018, 17 (10) :1013-1017. (in Chinese) 陈权, 张裕, 岳振东, 等.经颈静脉肝内门体分流术治疗肝移植术后再发门静脉高压症的临床疗效[J].中华消化外科杂志, 2018, 17 (10) :1013-1017.
    [2] DING ZF, YIN SW. Application of Viatorr covered stent in transjugular intrahepatic portosystemic shunt[J]. J Clin Hepatol, 2018, 34 (5) :1107-1110. (in Chinese) 丁智锋, 殷世武. Viatorr覆膜支架在经颈静脉肝内门体分流术中的应用现状[J].临床肝胆病杂志, 2018, 34 (5) :1107-1110.
    [3] ROSSLE M. TIPS:25 years later[J]. J Hepatol, 2013, 59 (5) :1081-1093.
    [4] RIGGIO O, ANGELONI S, SALVATORI M, et al. Incidence, natural history, and risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stent grafts[J]. Am J Gastroenterol, 2008, 103 (11) :2738-2746.
    [5] RIGGIO O, MASINI A, EFRATI C, et al. Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt:A randomized controlled study[J]. J Hepatol, 2005, 42 (5) :674-679.
    [6] CHU JG, SUN XL, PIAO LS, et al. The reducing stent:Treatment for transjugular intrahepatic portosystemic shunt-induced refractory hepatic encephalopathy[J]. J General Hospital Air Force, PLA, 2002, 18 (3) :125-128. (in Chinese) 褚建国, 孙晓丽, 朴龙松, 等.限流支架植入治疗TIPS引起的难治性肝性脑病[J].空军总医院学报, 2002, 18 (3) :125-128.
    [7] VILSTRUP H, AMODIO P, BAJAJ J, et al. Hepatic encephalopathy in chronic liver disease:2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J]. Hepatology, 2014, 60 (2) :715-735.
    [8] BAI M, QI X, YANG Z, et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients:A systematic review[J]. J Gastroenterol Hepatol, 2011, 26 (6) :943-951.
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    [10] WANG Q, LV Y, BAI M, et al. Eight millimeter covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding[J]. J Hepatol, 2017, 67 (3) :508-516.
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  • 期刊类型引用(2)

    1. 凌清儿,张戎. 肝纤维化治疗的研究进展. 现代医药卫生. 2023(11): 1926-1931 . 百度学术
    2. 揭阳,叶林茂,何怡,邵畅,孙希光,张俊杰. 基于IFN-γ/STAT1/Smad7通路探讨疏肝健脾活血方抗肝纤维化作用机制. 中华中医药杂志. 2023(09): 4136-4141 . 百度学术

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  • 收稿日期:  2019-03-08
  • 出版日期:  2019-08-20
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