门静脉高压症介入治疗术式的临床选择

The clinical choice in the method of interventional treatment to portal hypertension

目的 探讨在不同条件下选择合理治疗门静脉高压症的介入方式。方法 回顾分析1997～ 2 0 0 2年 5年间介入治疗的 76例门静脉高压症患者。经颈内静脉肝内门体分流术 (TIPSS)治疗2 6例 ,其中 11例为外科断流后再出血 ,6例为胃镜套扎后再出血 ,余 9例为内科保守治疗无效且无外科或胃镜套扎治疗史者。经皮经肝食管胃曲张静脉栓塞术 (PTVE)联合部分性脾栓塞 (PSE)治疗 5 0例 ,5 0例患者均为内科保守治疗无效者。所有 76例患者于治疗前后均测量自由门静脉压 (FPP) ,术前均由螺旋CT测量肝脏体积并于治疗 1年后复查。结果 TIPSS治疗组与PTVE联合PSE治疗组中门静脉压分别由术前 (3 85± 0 4 2 )kPa(1kPa =7 5mmHg)下降至术后 (3 0 9± 0 4 4 )kPa (P <0 0 1) ,(3 79± 0 5 1)kPa降至术后 (3 2 8± 0 5 7)kPa ,(P <0 0 1)。两组术后 1年再出血率分别为 0 % ,4 % ,肝性脑病发生率为 19 2 % (5 / 2 6 ) ,2 0 % (1/ 5 0 )。TIPSS组术后肝脏体积明显缩小而PTVE联合PSE组无明显改变。肝脏体积小于 70 0cm3 与大于 70 0cm3 者相比 ,TIPSS治疗后肝性脑病发生率明显增高 P<0 0 5 )。脾功能亢进均有效控制。结论 门静脉高压症介入治疗的 2种方式各有长短 ,应根据具体情况加以选择 ;肝脏体积是评估及选择治疗方?

Objective To explore the selection of reasonable interventional treatment to portal hypertension under different conditions.Methods The data of 76 patients with portal hypertension and interventional treatment from 1997 to 2002 were retrospectively analyzed. 26 patients were treated with transjugular intrahepatic porto-systemic stent shunt (TIPSS). Of these 26 patients, 11 patients suffered from hemorrhage after surgery treatment by devascularization, 6 patients with hemorrhage after stomach mirror treatment, and 9 patients with ineffective medicine treatment. 50 patients were treated with percutaneous transhepatic variceal embolization (PTVE) combined with partial splenic embolization (PSE), and they all showed inefficacy by medicine treatment. Free portal pressure (FPP) in pre- and post-treatment was measured in all 76 cases. The hepatic volume was measured by spiral-CT before and one year after the treatment.Results In TIPSS group, FPP was reduced from (3.85±0.42) kPa to (3.09±0.44) kPa (( t= 3.682, P<0.01), )in PTVE combined with PSE group, FPP was reduced from (3.79±0.51) kPa to (3.28±0.57 ) kPa (t=3.017, P<0.01). The recurring rate of hemorrhage after one year in TIPSS and PTVE combined with PSE group was 0% and 4%, respectively. The occurring rate of hepatic encephalopathy was 19.2% and 2.0%, respectively. The hepatic volume was significantly reduced after TIPSS, but no obvious changes after PTVE combined with PSE. The occurring rate of hepatic encephalopathy in patients with hepatic volume less than 700 cm^3 was obviously higher than those with volume more than 700 cm^3 after TIPSS (χ~2=4.37,P<0.05). Hypersplenism was completely resolved in both groups.Conclusion(The two kinds) interventional treatments for portal hypertension each have their own advantages and disadvantages. The selection of interventional treatment should be based on the actual needs of the patients. The hepatic volume is a diathesis of importance in the evaluation and selection of treatment methods.