门静脉不同部位分流治疗肝肺综合征术后近、中期血气变化

The short-to-mid-term blood gas changes after TIPS with the shunting established at different sites of portal vein for the treatment of hepatopulmonary syndrome

目的探讨采用门静脉不同部位分流治疗门静脉高压合并肝肺综合征（HPS）患者的近、中期血气变化的临床意义。方法2008年7月-2013年5月对诊断明确的HPS患者行经颈静脉肝内门体分流术（TIPS），对其中81例资料完整的患者进行回顾性分析。81例中，行门静脉主干分流30例（A组），左支分流24例（B组），右支分流27例（C组）。术后常规随访3～12个月，比较门静脉不同部位分流前后平卧不吸氧状态肺泡动脉氧分压差（A—aPO2）、动脉血氧分压（PaO：）和氧饱和度（S02）。结果随访半个月时，A组和B组A—aPO2、PaO2和SO2明显改善，与术前相比差异均有统计学意义（P〈0．05），C组则差异无统计学意义（P〉0．05）。随访3个月时，A组和B组的A—aPO2、PaO2和SO2仍较术前改善，差异有统计学意义（P〈0．05），C组仅A—aPO2较术前差异有统计学意义（P〈0．05）。随访12个月时，B组A—aPO2、PaO2和SO2仍较术前差异有统计学意义（P〈0．05），A组和C组则差异无统计学意义（P〉0．05）。结论采用经门静脉主干或左支TIPS分流可以改善HPS的低氧症状，提高动脉血氧分压．对HPS的近、中期疗效明显．左支分流效果更佳．

Objective To discuss the short- to- mid- term blood gas changes in patients with hepatopulmonary syndrome （HPS） after receiving TIPS with the shunting established at different sites of portal vein. Methods During the period from July 2008 to May 2013, transjugular intrahepatic portosystemic shunting （TIPS） was employed in treating clinically-proved HPS at the hospital. A total of 81 cases had complete material, and their clinical data were retrospectively analyzed. Of the 81 cases, shunting was established at the main branch of portal vein in 30 （group A）, at the left branch of portal vein in 24 （Group B） and at the fight branch of portal vein in 27 （Group C）. After TIPS all the patients were followed up for 3- 12 months. With the patients laying in horizontal position and receiving no oxygen inhalation, A-aPO2, PaO2 and SO2 levels were determined both before and after TIPS. The results were analyzed and compared between each other among the three groups by using paired t-test. Results Half months after TIPS, A-aPO2, PaO2 and SO2 levels of group A and group B showed a significant improvement when compared with those determined before TIPS （P 〈 0.05）, while no significant differences in A-aPO2, PaO2 and SOs levels werefound in group C after TIPS （P 〉 0.05）. Three months after TIPS, A- aPO：, PaO2 and SO2 levels of group A and group B still showed an obvious improvement when compared with those determined before TIPS （P 〈 0.05）, while in group C only the A- aPO2 level showed a significant improvement whencompared with that determined before TIPS （P 〈 0.05）. Twelve months after TIPS, A-aPO2, PaO2 and S（）2 levels of group B still showed a significant improvement when compared with those determined before TIPS （P 〈 0.05）, while those of group A and group C showed no significant changes when compared with those determined before TIPS （P 〉 0.05）. Conclusion In performing TIPS for the treatment of hepatopulmonary syndrome, to establish the shunting at the main branch of portal vein or at the left branch of portal vein can effectively relieve the symptoms of hypoxia, increase the PO2 level, and improve the short- to- mid- term efficacy.