[1]赵洪伟,刘福全,岳振东,等. 应用覆膜支架TIPS治疗不同类型慢性门静脉血栓术后肝性脑病发生探讨[J].介入放射学杂志,2014,(08):672-678.
 ZHAO Hong wei,LIU Fu quan,YUE Zhen dong,et al.A preliminary study on the occurrence of hepatic encephalopathy after TIPS using covered stent for different types of chronic portal vein thrombosis[J].journal interventional radiology,2014,(08):672-678.
点击复制

 应用覆膜支架TIPS治疗不同类型慢性门静脉血栓术后肝性脑病发生探讨 ()

PDF下载中关闭

分享到:

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2014年08期
页码:
672-678
栏目:
血管介入
出版日期:
2014-08-25

文章信息/Info

Title:
A preliminary study on the occurrence of hepatic encephalopathy after TIPS using covered stent for different types of chronic portal vein thrombosis
作者:
赵洪伟 刘福全 岳振东 王 磊 范振华 董成宾
Author(s):
 ZHAO Hong wei LIU Fu quan YUE Zhen dong WANG Lei FAN Zhen hua DONG Cheng bing.
Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
关键词:
【关键词】 肝性脑病 经颈静脉肝内门体静脉分流术 门静脉血栓 覆膜支架
文献标志码:
A
摘要:
【摘要】 目的 通过建立慢性门静脉血栓解剖分型指导临床TIPS操作,探讨分析不同类型门静脉血栓术后肝性脑病(HE)的发生与TIPS术式选择的关系。方法 20106月—20136月收治慢性门静脉血栓患者73例,行Fluency覆膜支架TIPS治疗。根据门静脉系统血栓不同部位,建立门静脉系统血栓解剖分型,评估TIPS手术前后门静脉压力变化、不同类型血栓患者接受TIPS治疗后15 d36个月出现HE状况及病例数,并进行同一时间组间和不同时间变化对比。结果 TIPS治疗中Ⅰ型患者的分流前、后的门静脉压力分别为(42.7 ± 9.6)和(35.0 ± 6.7cm H2O,差异有统计学意义(P < 0.01);Ⅱ型患者分别为(39.8 ± 5.5)和(31.0 ± 5.7cm H2O,差异有统计学意义(t = 17.2P < 0.01);Ⅲ型患者TIPS分别为(43.2 ± 5.8)和(32.4 ± 5.0cm H2O,差异有统计学意义(t = 25.0P <0.01);Ⅳ型患者分别为(43.0 ± 3.7)和(36.6 ± 6.6cm H2O,差异有统计学意义(t = 4.26P < 0.01)。术后15 d时发生轻微HEMHE)的前三者为Ⅳ、Ⅰ和Ⅲb型,发生Ⅰ期HE前三者为Ⅱa、Ⅲb和Ⅰ型,发生Ⅱ期HE的前三者为Ⅱb、Ⅲb和Ⅰ型;术后3个月时发生MHE的前三者为Ⅲa、Ⅱa和Ⅱc型,发生Ⅰ期HE的前三者为Ⅲa、Ⅱb和Ⅳ型,发生Ⅱ期HE的前三者为Ⅱa、Ⅱb和Ⅲb型;术后6个月时发生MHE的前三者为Ⅱa、Ⅱc和Ⅲb型,发生IHE的前三者为Ⅱb、Ⅰ和Ⅲb型,发生Ⅱ期HE的前三者为Ⅱb、Ⅲb和Ⅰ型;且Ⅱb、Ⅲb和Ⅰ型TIPS术后HE持续时间较长。结论 建立合理的慢性门静脉系统血栓解剖分型可以有效的指导临床TIPS的应用,术后HE在单纯门静脉主干和单纯肠系膜上静脉血栓中的发生概率较高。

 

参考文献/References:

[1] Francoz C, Valla D. Portal vein thrombosis, cirrhosis, and liver transplantation[J]. J Hepatol, 2012, 57: 203 212.
[2] Qi X, Han G, He C, et al. Transjugular intrahepatic portosystemic shunt May be superior to conservative therapy for variceal rebleeding in cirrhotic patients with non tumoral portal vein thrombosis: a hypothesis[J]. Med Sci Monit, 2012, 18: 37 41.
[3] 刘福全, 岳振东, 赵洪伟, 等. 经颈静脉肝内门-体分流术后再次介入治疗肝硬化门静脉高压长期疗效及再次手术原因分析[J]. 中华放射学杂志, 2012, 46: 830 835.
[4] 赵洪伟, 刘福全, 岳振东, 等. 经颈静脉途径介入性干预TIPS分流后肝性脊髓病的临床疗效评价[J]. 中华放射学杂志, 2013, 47: 239 244.
[5] 吴 勤, 楚金东, 金 波, 等. 肝硬化后门静脉血栓形成的临床特点研究[J]. 传染病信息, 2013, 26: 164 167.
[6] Senzolo M, M SM, Rossetto V, et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis[J]. Liver Int, 2012, 32: 919 927.
[7] Plessier A, Rautou PE, Valla DC. Management of hepatic vascular diseases[J]. J Hepatol, 2012, 56: 1025 1038.
[8] Senzolo M, Burra P, Patch D, et al. Tips for portal vein thrombosis(pvt)in cirrhosis: not only unblocking a pipe[J]. J Hepatol, 2011, 55: 945 946.
[9] Luca A, Miraglia R, Caruso S, et al. Short and long term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis[J]. Gut, 2011, 60: 846 852.
[10] Rajani R, Bj?觟rnsson E, Bergquist A, et al. The epidemiology and clinical features of portal vein thrombosis: amulticentrestudy[J]. Aliment Pharmacol Ther, 2010, 32: 1154 1162.
[11] Perarnau JM, Baju A, D’alteroche L, et al. Feasibility and long term evolution of TIPS in cirrhotic patients with portal thrombosis[J]. Eur J Gastroenterol Hepatol, 2010, 22: 1093 1098.
[12] Funes FR, Silva RC, Arroyo PC, et al. Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt(TIPS) 12 years experience[J]. Arq Gastroenterol, 49: 143 149.
[13] Bai M, Han GH, Yuan SS, et al. Early hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: the risk factors and long time survival[J]. Zhonghua Gan Zang Bing Za Zhi, 2011, 19: 498 501.
[14] 王 磊, 刘福全, 岳振东, 等. 应用介入技术建立猪肝硬化门脉高压模型的实验研究[J]. 介入放射学杂志, 2012, 21: 756 759.
[15] Riggio O, Mannaioni G, Ridola L, et al. Peripheral and splanchnic indole and oxindole levels in cirrhotic patients: a study on the pathophysiology of hepatic encephalopathy[J]. Am J Gastroenterol, 2010, 105: 1374 1381.

相似文献/References:

[1]陈云燕.TIPSS的并发症[J].介入放射学杂志,1994,(03):174.
[2]冯艳姣,崔进国,田惠琴,等.经肠系膜上动脉门脉造影术血管扩张药的应用[J].介入放射学杂志,1994,(04):231.
[3]陈斯良,胡 朋,林志鹏,等.经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压症脾切除断流术后症状复发临床效果 [J].介入放射学杂志,2018,27(04):374.
 CHEN Siliang,HU Peng,LIN Zhipeng,et al.TIPS for the treatment of recurrent symptoms in patients with cirrhotic portal hypertension after splenectomy devascularization: analysis of clinical efficacy[J].journal interventional radiology,2018,27(08):374.
[4]万 里,张文广,任建庄,等.限流支架治疗经颈静脉肝内门体分流术后难治性肝性脑病效果和安全性分析[J].介入放射学杂志,2021,30(07):662.
 WAN Li,ZHANG Wenguang,REN Jianzhuang,et al.Flow-reducing stent for TIPS-induced refractory hepatic encephalopathy: analysis of its effectiveness and safety[J].journal interventional radiology,2021,30(08):662.

备注/Memo

备注/Memo:
 (收稿日期:2014-01-08)
(本文编辑:侯虹鲁)
更新日期/Last Update: 2014-08-22