PTIPS治疗脾切除术后并发门静脉血栓形成的门静脉高压症患者安全性和效果分析

Safety and efficacy of percutaneous transhepatic intrahepatic portosystemic shunt in management of patients with portal thrombosis after splenectomy

目的探讨经皮经肝肝内门体分流术(PTIPS)治疗脾切除术后并发门静脉血栓形成的门静脉高压症患者的安全性和效果。方法回顾性分析2011年1月～2015年12月在我院接受PTIPS治疗的30例脾切除术后并发门静脉血栓形成的门静脉高压症患者的病历资料,采用经皮经肝穿刺门静脉分支,采用球囊扩张术扩张闭塞的门静脉和肝内门体分流道,在分流道内植入8 mm的金属支架处理,使用320排CT机检查,随访(22.1±3.8)个月。结果在30例接受PTIPS术患者中,27例(90.0%)手术成功,3例(10.0%)患者因术中未能开通门静脉闭塞而终止手术;27例手术成功患者术前门体静脉压力梯度为(21.5±3.4)mm Hg,术后下降至(13.0±2.8)mm Hg,差异具有统计学意义(t=10.0,P<0.05);术后CT检查,发现4例(13.3%)患者发生分流道支架闭塞,均及时给予球囊扩张并再次置入支架处理,血管再通,2例(6.7%)患者发生肝性脑病,给予降血氨药物和营养支持等治疗后好转;5例(16.7%)患者死亡,其中3例死于肝功能衰竭,2例死于脑出血。结论采用PTIPS处理脾切除术后并发门静脉血栓形成的门静脉高压症患者疗效较好,创伤小、较安全,未来仍需进一步深入研究其应用适应证和并发症处理等问题。

Objective To investigate the safety and efficacy of percutaneous transhepatic intrahepaticportosystemic shunt（PTIPS）in management of patients with portal thrombosis after splenectomy. Methods Thirtypatients with portal thrombosis after splenectomy were recruited in our hospital between January 2011 andDecember 2015. All patients received PTIPS, checked-up by CT scan and followed-up for（22.1±3.8）m. ResultsThe success rate of the operation was 90% （27/30）, and3 patients failed to opening their portal vein occlusionduring operation. No serious complications such as surgical related death were found in this series. The portal-systemic pressure gradient decreased from（21.5±3.4）mmHg to（13±2.8）mmHg in the 27 patients with successfuloperation. During the follow-up period,4 patients（13.3%）got the shunt stent occlusion, and repatency by balloondilatation anda new stent placed instead. 2 patients（6.7%）had hepatic encephalopathy within1 months after theoperation, and were improved after appropriate treatment.5 （16.7%）patients died of hepatic failure or cerebralhemorrhage. Conclusion The application of PTIPS in the management of patients with portal thrombosis aftersplenectomy is effective, and the procedure is feasible and safe. Further study is still needed in the future to getthe indications of this operation.