经颈静脉肝内门体分流术治疗原发性胆汁性肝硬化门静脉高压的效果及安全性

Therapeutic effect and safety of transjugular intrahepatic portosystemic shunt in patients with primary biliary cirrhosis and portal hypertension

目的探讨经颈静脉肝内门体分流术（TIPS）应用于失代偿期原发性胆汁性肝硬化（PBC）患者的短期疗效及安全性。方法对2009年1月-2015年5月于南京大学医学院附属鼓楼医院行TIPS治疗的26例失代偿期PBC患者的临床数据进行回顾性分析。对比术前术后门静脉压力、肝功能、生存率等指标及术后1年的随访情况。用Friedman检验进行多个相关样本的秩和检验,Wilcoxon检验进行配对秩和检验,对整个随访期内患者生存率作Kaplan-Meier分析曲线。结果 26例患者术后平均门静脉压力为19.11（16.35～22.05）mm Hg,较术前27.93（25.26～30.87）mm Hg显著下降,差异具有统计学意义（Z=-4.199,P〈0.001）。术后3个月内TBil、终末期肝病模型评分、胆汁酸等较术前明显上升（χ2值分别为26.000、18.429、16.353,P值均〈0.001）。术后最常见并发症为发热,发生率为80.77%（21/26）,其次为肝性脑病,发生率为19.23%（7/26）,术后6、12个月生存率均为92.3%（24/26）。结论 TIPS治疗失代偿期PBC患者短中期疗效及安全性较好,长期疗效尚需进一步观察。

Objective To investigate the short - term effect and safety of transjugnlar intrahepatic portosystemic shunt （TIPS） in the treat- ment of decompensated primary biliary cirrhosis （PBC）. Methods The clinical data of 26 patients with decompensated PBC who received TIPS in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2009 to May 2015 were analyzed retrospectively. The indicators including portal venous pressure, liver function, and survival before and after TIPS during 1 year of follow up were compared. The Friedman test was applied as the rank sum test for multiple related samples, the Wilcoxon test was applied as the paired rank sum test, and the Kaplan -Meier curve was applied for survival analysis. Results All patients had significantly reduced mean portal pressure after TIPS（1911 （16.35 -22.05） mmHg vs 27.93 （25.26 -30.87） mmHg; Z= -4. 199, P〈0.001）. Within 3 months after TIPS, the pa- tients showed significant increases in total bilirubin, Model for End -Stage Liver Disease score, and bile acid （X2 = 26. 000, 18. 429, and 16. 353, all P 〈 0. 001 ）. The most common postoperative complication was pyrexia, which had an incidence rate of 80.77% （21/26）, fol- lowed by hepatic encephalopathy, with an incidence rate of 19.23% （7/26）. The survival rates at 6 and 12 months after surgery were both 92.3% （24/26）. Conclusions TIPS has good short - to medium - term effect and safety in the treatment of decompensated PBC, and its long- term effect still needs to be proved.