经颈静脉肝内门体分流术治疗土三七致肝窦阻塞综合征的疗效

Efficacy of transjugular intrahepatic portosystemic shunt in treatment of sinusoidal obstruction syndrome caused by gynura segetum

目的探讨经颈静脉肝内门体分流术(TIPS)治疗土三七致肝窦阻塞综合征(SOS)的安全性及疗效。方法回顾性分析2017年2月至2018年6月徐州医科大学附属医院收治的土三七致SOS施行TIPS治疗的9例患者临床资料,男5例,女4例,术前Child-Pugh评分(9.5±1.3)分,终末期肝病模型(MELD)评分(12.5±5.0)分。观察患者手术成功率、并发症及临床随访结果。结果9例患者均成功施行了TIPS,门静脉压力梯度由术前(22.4±2.7)mmHg(1mmHg=0.133kPa)降至术后(10.4±3.2)mmHg(P<0.05)。无腹腔内出血、胆汁性腹膜炎等并发症。9例患者随访1~17(7.8±6.0)个月。术后1个月,Child-Pugh评分降至(7.1±1.8)分,与术前评分相比,差异有统计学意义(P<0.05)。MELD评分降至(5.3±4.6)分,与术前评分相比,差异有统计学意义(P<0.05)。至随访终点,彩色多普勒超声及门静脉CT血管造影示9例患者TIPS分流道均通畅,肝淤血情况均缓解。全部患者均存活。结论采用TIPS治疗土三七致SOS安全、有效。

Objective To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of sinusoidal obstruction syndrome (SOS) caused by gynura segetum. Methods The clinical data of 9 patients with SOS caused by gynura segetum (5 males and 4 females) who underwent TIPS were retrospectively analyzed from February 2017 to June 2018. The Child-Pugh scores were (9.5±1.3) and the MELD scores were (12.5±5.0). The success rates, complications and follow-up results were evaluated. Results TIPS was performed successfully in all the 9 patients. The portal venous pressure gradient dropped from (22.4±2.7) mmHg to (10.4±3.2) mmHg (P<0.05). There was no complication such as abdominal hemorrhage and biliary peritonitis. Nine patients were followed-up for 1~17months, mean 7.8±6.0 months. One month after treatment, the Child-Pugh scores were (7.1±1.8), compared with that of the preoperative scores, the difference was statistically significant (P<0.05). The MELD scores were (5.3±4.6), compared with that of the preoperative scores, the difference was also statistically significant (P<0.05). At the end point of the follow-up, color Doppler ultrasound and portal CTA showed that the TIPS shunt was patent and hepatic congestion was relieved in all the 9 patients. All patients were alive. Conclusion TIPS was a safe and efficacious treatment for SOS caused by gynura segetum.