直接性门腔分流与TIPS术的比较研究

Contrastive Study of DIPS and TIPS

目的:探讨在肝内门静脉与肝后段下腔静脉(RHSIVC)之间建立直接性门腔分流(DIPS)的可行性及安全性;比较DIPS术与TIPS术后的并发症、临床疗效及分流道通畅情况。材料和方法:随机将需行介入治疗的肝硬化门脉高压患者分入DIPS(D组)及TIPS(T组)。分别对两组患者实施直接性门腔分流(D组)及传统TIPS术(T组),对两组患者术前、术后各实验室检查值及门腔压力差的改变、分流道参数、术后30d的临床疗效及随访期内出现的并发症进行比较,并用彩超对两组患者分流道的通畅情况进行随访。结果:共30例(男/女27/3)门脉高压患者(其中3例合并肝癌)入选本组研究,平均年龄(54.83±13.33)岁(31~76岁)。分组后,D组14例,T组16例。所有介入性门腔分流术均成功。D组、T组患者分流道的平均初次通畅时间分别为(188±19.8)d及(171.3±15.8)d;两组差异无显著性(P=0.648)。结论:直接性门腔分流安全、可行;DIPS术后的并发症、近期临床疗效及分流道的通畅性与TIPS术后接近,有望成为治疗门脉高压及其并发症的新措施。

Purpose： To evaluate the feasibility and safety of creating direct intrahepatic portacaval shunt （DIPS） between portal vein and retrohepatic segment of inferior vena cava （RHSIVC）. To compare the events of complications, post - procedure 30 days＇ therapeutic effect and short - term patency of shunt after DIPS with those after TIPS procedure. Materials and Methods： Cirrhotic patients needed for interventional therapy were assigned into group D （DIPS） and group T （TIPS） randomly. DIPS and TIPS procedure was performed on the patients of group D and T respectively. Changes of patient＇ s laboratory examination values, portosystemic pressure gradient, parameters of intrahepatic portac^aval shunt, post - procedure 30 days＇ therapeutic effect and events of complications during follow - up were compared one by one be- tween 2 groups. Patency of shunt was followed by color doppler sonograph and analyzed by Kaplan - Meier analysis. Results：30 cirrhotic patients （M/F 27/3） were enrolled into this study. 14 and 16 patients were assigned into group D and group T respectively. All intrahepatic portosystemic shunts were successfully created in these 30 patients. Kaplan- Meier analysis of two groups yielded a primary patency of（188± 19.8）d for group D and（171.3 ±15.8）d for group T respectively （P = 0.648）. Conclusion： Our initial experience demonstrated that DIPS was feasible and safe and will become a new interventional approach for treating portal hypertension.