[1]李如春,胡继红,潘文秋,等.TIPS治疗肝硬化伴或不伴门静脉血栓临床对比研究[J].介入放射学杂志,2024,33(10):1101-1106.
 LI Ruchun,HU Jihong,PAN Wenqiu,et al.TIPS for the treatment of cirrhosis with or without portal vein thrombosis:a comparative study[J].journal interventional radiology,2024,33(10):1101-1106.
点击复制

TIPS治疗肝硬化伴或不伴门静脉血栓临床对比研究()

PDF下载中关闭

分享到:

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

卷:
33
期数:
2024年10
页码:
1101-1106
栏目:
临床研究
出版日期:
2024-10-21

文章信息/Info

Title:
TIPS for the treatment of cirrhosis with or without portal vein thrombosis:a comparative study
作者:
李如春胡继红潘文秋卓松波张玉博田梽甫
Author(s):
LI RuchunHU JihongPAN WenqiuZHUO SongboZHANG YuboTIAN Zhifu.
Department of Medical Imaging,First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan Province 650032,China
关键词:
【关键词】肝硬化门静脉血栓形成消化道出血经颈静脉肝内门体分流术
文献标志码:
A
摘要:
【摘要】目的分析TIPS治疗肝硬化伴或不伴门静脉血栓形成(portal vein thrombosis,PVT)的临床特点及疗效。方法回顾性分析2018年10月至2022年10月在昆明医科大学第一附属医院接受TIPS治疗的肝硬化伴消化道出血患者193例,按术前有无PVT分为非PVT组118例,PVT组75例。分别于术后1、3、6个月及之后每6个月随访,观察PVT对肝硬化患者临床特征及TIPS术后疗效的影响。结果两组患者手术成功率均为100%。PVT组行脾脏切除或行分脾动脉栓塞术占26.7%(20/75),高于非PVT组的13.6%(16/118),差异有统计学意义(χ2=5.192,P=0.023)。PVT组患者术前Child-Pugh评分、MELD评分和MELD-Na+评分分别为(8.1±1.9)分、(9.2±8.0)分、(9.2±8.0)分,均高于非PVT组的(7.4±1.9)分、(7.7±5.8)分、(7.7±5.8)分,差异有统计学意义(P<0.05)。PVT组显性肝性脑病发生率33.3%(25/75)高于非PVT组19.5%(23/118),差异有统计学意义(P=0.030)。而术后生存率、再出血率和支架失功能率,两组差异无统计学意义(P>0.05)。结论TIPS用于治疗肝硬化PVT伴消化道出血安全、有效;PVT患者的肝功能更差,TIPS术后显性肝性脑病发生率更高。

参考文献/References:

[1]Nery F,Chevret S,Condat B,et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis:results of a longitudinal study[J]. Hepatology,2015,61:660-667.
[2]Intagliata NM,Caldwell SH,Diagnosis TA. Development,and treatment of portal vein thrombosis in patients with and without cirrhosis[J]. Gastroenterology,2019,156:1582-1599.
[3]张瑞,马丽黎.门静脉血栓影响肝硬化进程与食管胃静脉曲张处理[J].中国实用内科杂志,2022,42:820-823,830.
[4]祁兴顺,杨玲.肝硬化门静脉血栓管理专家共识(2020年上海)[J].临床肝胆病杂志,2020,36:2667-2674.
[5]Northup PG,Garcia-Pagan JC,Garcia-Tsao G,et al. Vascular liver disorders,portal vein thrombosis,and procedural bleeding in patients with liver disease:2020 practice guidance by the American Association for the Study of Liver Diseases[J]. Hepatology,2021,73:366-413.
[6]European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis:2021 update[J]. J Hepatol,2021,75:659-689.
[7]曹家伟,丁鹏绪,段峰,等.中国门静脉高压经颈静脉肝内门体分流术临床实践指南(2019年版)[J].临床肝胆病杂志,2019,35:2694-2699.
[8]尹晓春,张峰,肖江强,等.经颈静脉肝内门体分流术治疗食管-胃底静脉曲张破裂出血伴门静脉海绵样变的疗效分析[J].中华消化杂志,2021,41:685-691.
[9]Wang HL,Lu WJ,Zhang YL,et al. Comparison of transjugular intrahepatic portosystemic shunt in the treatment of cirrhosis with or without portal vein thrombosis:a retrospective study[J]. Front Med(Lausanne),2021,8:737984..
[10]Qi X,He C,Guo W,et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with variceal bleeding in liver cirrhosis:outcomes and predictors in a prospective cohort study[J]. Liver Int,2016,36:667-676.
[11]Wu W,Zhang H,Zeng Z,et al. Comparison of transjugular intrahepatic portosystemic with endoscopic treatment plus anticoagulation for esophageal variceal bleeding and portal vein thrombosis in liver cirrhosis[J]. Scand J Gastroenterol,2022,57:1494-1502.
[12]吴凡,甘洪颖,吴杰,等.经颈静脉肝内门体分流术与内镜下组织胶联合硬化剂注射术对门静脉血栓的影响[J].临床消化病杂志,2020,32:251-255.
[13]Zhu R,Liu L,Zhang G,et al. The pathogenesis of gut microbiota in hepatic encephalopathy by the gut-liver-brain axis[J]. Biosci Rep,2023,43:BSR20222524.
[14]Huang X,Fan X,Zhang R,et al. Systemic inflammation and portal vein thrombosis in cirrhotic patients with gastroesophageal varices[J]. Eur J Gastroenterol Hepatol,2020,32:401-405.
[15]Ma L,Ma J,Zhang W,et al. Acute hepatic ischemia after transjugular intrahepatic portosystemic shunt creation despite preserved arterial perfusion[J]. J Vasc Interv Radiol,2021,32:1510-1512.
[16]Philips CA,Augustine P. Gut barrier and microbiota in cirrhosis[J]. J Clin Exp Hepatol,2022,12:625-638.
[17]袁巍,李龙鹤,韩晓玉,等.TIPS术后发生肝性脑病的临床预测模型建立与效能分析[J].现代消化及介入诊疗,2021,26:874-877.
[18]Jaffe A,Lim JK,Jakab SS. Pathophysiology of hepatic encephalopathy[J]. Clin Liver Dis,2020,24:175-188.
[19]于翔,谢坪,成思航,等.经颈静脉肝内门体分流术前外周血炎症指标对术后肝性脑病的预测价值[J].介入放射学杂志,2021,30:937-940.
[20]Iwakiri Y,Trebicka J.Portal hypertension in cirrhosis:pathophysiological mechanisms and therapy[J]. JHEP Rep,2021,3:100316.
[21]Shukla A,Giri S. Portal vein thrombosis in cirrhosis[J]. J Clin Exp Hepatol,2022,12:965-979.


备注/Memo

备注/Memo:
(收稿日期:2023-11-02)
(本文编辑:新宇)
更新日期/Last Update: 2024-10-17