经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压症脾切除断流术后症状复发临床效果

TIPS for the treatment of recurrent symptoms in patients with cirrhotic portal hypertension after splenectomy devascularization: analysis of clinical efficacy

目的探讨经颈静脉肝内门体静脉分流术(TIPS)治疗肝硬化门静脉高压症脾脏断流术后症状复发的临床效果。方法回顾性分析2010年1月至2015年12月因肝硬化门静脉高压症接受TIPS术治疗的192例患者临床资料。其中既往接受过脾切除断流术48例(A组),未接受脾切除断流术144例(B组)。采用Cox回归模型分析影响术后疗效及预后的因素。对比分析两组术后门静脉高压症状缓解情况及临床疗效。结果 TIPS术后192例患者均成功建立肝内门体分流道,随访5~65个月,平均(35.13±7.68)个月。TIPS术前、术后A组血小板计数均高于B组(P<0.01),A组术后远期肝功能优于B组(P<0.05),A组术后肝性脑病(HE)发生率低于B组(P<0.05),两组术后分流道通畅率及生存率差异均无统计学意义(P>0.05)。肝硬化门静脉高压症脾脏断流术后症状复发患者随访9~64个月,TIPS术后门静脉高压症状可在短期内有效缓解。Cox回归模型分析显示术前Child-Pugh评分(HR=1.653,95%CI=1.721~3.298,P=0.003)、HE(HR=1.023,95%CI=0.908~0.965,P=0.008)及脾切除(HR=0.981,95%CI=1.019~1.584,P=0.041)是影响术后HE的独立影响因素。结论 TIPS术治疗肝硬化门静脉高压症脾切除断流术后症状复发患者效果良好。术前接受脾切除断流术对术后支架分流道通率及生存率无明显影响,术后HE发生率较低,可能获得较好的远期肝功能。

Objective To evaluate the clinical efficacy of transjugular intrahepatic portosystemic shunt （TIPS） in treating recurrent symptoms in patients with cirrhotic portal hypertension after splenectomy devascularization. Methods The clinical data of 192 patients with cirrhotic portal hypertension, who received TIPS during the period from January 2010 to December 2015, were retrospectively analyzed. Of the 192 patients, 48 had received splenectomy devascularization （group A） and 144 had not received splenectomy devaseularization （group B）. Cox regression model was used to analyze the factors that might affect the postoperative outcome and prognosis. The relief of portal hypertension symptoms and the clinical efficacy after TIPS were compared between the two groups. Results After TIPS, the intrahepatic portosystemic shunt channel was successfully established in all 192 patients. The patients were followed up for 5-65 months, with a mean of （35.13±7.68） months. Before TIPS, the platelet count in group A was higher than that in group B （P〈0.01）, the postoperative long-term hepatic function in group A was better than that in group B （P〈0.05）, the incidence of postoperative hepatic encephalopathy （HE） in group A was lower than that in group B （P〈0.05）, and the differences in the postoperative patency rate of intrahepatic portosystemic shunt channel and in the survival rate between the two groups were not statistically significant （P〉0.05）. The patients with cirrhotic portal hypertension who had recurrent symptoms after splenectomy devascularization were followed up for 9- 64 months, their symptoms of portal hypertension could be effectively relieved after TIPS. Cox regression model analysis indicated that preoperative Child-Pugh score （HR=1.653, 95%CI：1.721-3.298, P=0.003）, preoperative presence of HE （HR=1.023, 95%CI：0.908-0.965, P=0.008） and preoperative splenectomy devascularization （HR=0.981, 95%CI： 1.019-1.584, P=0.041） were the independent factors influencing the occurrence of HE after TIPS. Conclusion In treating patients with cirrhotic portal hypertension who have recurrent symptoms after splenectomy devascularization, TIPS has excellent curative effect. Preoperative splenectomy devascularization has no obvious influence on the postoperative patency rate of intrahepatic portosystemic shunt channel as well as on the survival rate. After TIPS, the incidence of HE is very low and a better long-term liver function can be expected.