经颈静脉肝内门体静脉分流术治疗肝硬化静脉曲张出血预后因素分析

The analysis of prognostic factors in treating variceal hemorrhage of liver cirrhosis and portal hypertension with transjugular intrahepatic portosystemic shunt

目的分析经颈静脉肝内门体静脉分流（TIPS）术治疗肝硬化静脉曲张出血患者的预后因素。方法收集2003年1月至2008年12月162例行TIPS术的肝硬化静脉曲张出血患者基本资料、术前7d内相关生化指标，定期随访观察术后情况和生存期资料。Cox回归模型评估影响预后生存的指标。结果TIPS术成功率99％（161／162）。中位随访时间21个月。Child—Pugh评分和血小板计数与生存密切相关（P值分别=0．003和0．024）。Child—Pugh评分〈9分者的累积生存率E75％（102／136）]高于评分≥9分者[-50%（13／26），）（x2=9．12，P=0．0031。血小板计数〉47×10^9／L者的累积生存率[74％（82／112）]高于≤47×10^9／L者[66％（33／50），x2=4．528，P=0．0331。肝功能Child—PughA、B、C级术后1年累积生存率分别为92％、85％、55％。结论Child—Pugh评分和血小板计数是预测TIPS术治疗肝硬化静脉曲张出血者生存情况的独立因素，当ChildPugh评分≥9分和（或）血小板计数≤47×10^9／L时术后危险性增加。

Objective To analyze the prognostic factors in treating variceal hemorrhage patients of liver cirrhosis and portal hypertension with transjugular intrahepatic portosystemic shunt （TIPS）. Methods From January 2003 to December 2008, the data of 162 variceal hemorrhage patients with liver cirrhosis and portal hypertension treated with TIPS was collected, which included basic information, biochemical examination results within 7 days before the operation, regular follow-up observation after the surgery and survival data. The survival prognostic indexes were assessed with Cox regression model. Results The successful rate of TIPS was 99~/00 （161/162）. The median follow up duration was 21 months. Child Pugh score and blood platelet count （PLT） were closely correlated with survival （P=0. 003 and 0. 024）. The total cumulative survival rate in patients with Child-Pugh score below nine （75%, 102/136） was higher than over nine （50%,13/26） （x2=9.12,P 0.003）. The total cumulative survival rate of patients with PLT count over 47 ×10^9/L （74%0, 82/112） was higher than below 47×10^9/L（66%,33/50, X2=4. 528,P=0. 033）. The one year after operation cumulative survival rate of liver function Child-Pugh class A, B, and C was 92%, 85%, 55% respectively. Conclusion Child Pugh score and platelet count are independent predictable factors for the survival of variceal hemorrhage patients with liver cirrhosis and portal hypertension treated by TIPS. The risk increase after operation when Child-Pugh score over 9 and/or PLT count less 47×10^9/L.