应用TIPS技术治疗顽固性腹腔积液的临床疗效分析

Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on refractory ascites

目的探讨应用TIPS技术治疗肝硬化门静脉高压症引起的顽固性腹腔积液临床疗效。方法对接受TIPS技术治疗成功的肝硬化顽固性胸腹腔积液患者427例进行术前和术后长期随访分析。结果手术成功率99.30%(427/430),术后随访胸腹腔积液完全消失85.25%(364/427)、有效8.43%(36/427)、无效6.32%(27/427);术后分流道累积再狭窄率:半年、1年、2年、3年、4年、5年分别为:3.98%(17/427)、18.49%(76/411)、27.39%(103/376)、37.43%(125/334)、46.01%(121/263)、58.54%(120/205);术后生存率:半年、1年、2年、3年、4年、5年分别为:99.53%(425/427)、96.59%(397/411)、87.23%(328/376)、81.14%(271/334)、73.38%(193/263)、57.56%(118/205)。无与手术相关的死亡病例。结论 TIPS治疗肝硬化门静脉高压顽固性胸腹腔积液安全有效,可作为此类疾患的常规治疗方法,值得临床推广。

Objective To investigate the clinical efficacy o f applicating TIPS treatment of cirrhosis and portal hypertension caused refractory pleural effusion and ascites. Methods In the retrospective study, 427 consecutive patients with cirrhosis and portal hypertension caused refractory pleural effusion and ascites who have received TIPS treatment were followed-up and analyzed. Results The success rate of TIPS were 99.30% （427/430） and there were 85.25% （364/427） patients whose symptoms of pleural efiusion and ascites were completely disappeared post-TIPS, besides 8.43% （36/427） were effective and 6.32% （27/427） were ineffective; Cumulative rate of shunt dysfunction post-TIPS were 3.98% （17/427）, 18.49% （76/411）, 27.39% （103/376）, 37.43% （125/334）, 46.01% （121/263） and 58.54% （120/205） respectively in 6 months, 1 year, 2 years, 3 years, 4 years and 5 years; The survival rate were 99.53% （425/427）, 96.59% （397/411）, 87.23% （328/376）, 81.14% （271/334）, 7338% （193/263）, 57.56% （118/205） respectively in 6 months, 1 year, 2 years, 3 years, 4 years and 5 years. No deaths associated with TIPS-operation in the study. Conclusions TIPS should be considered a safe, effective and conventional therapy for cirrhosis and portal hypertension caused refractory pleural effusion and ascites of such disorders, worthy of promotion.