经颈静脉肝内门体分流术初步分析门静脉系统肝脏相关血液成分

Preliminary analysis of liver-related blood components in portal vein system via TIPS approach

目的初步了解肝硬化失代偿期患者门静脉系统重要的肝脏相关血液成分分布,为研究经颈静脉肝内门体分流术(TIPS)对其影响打下基础。方法收集乙型肝炎肝硬化门静脉高压伴上消化道出血患者15例临床资料。其中男10例,女5例,平均年龄54.5岁。TIPS术时穿刺门静脉干或左右分支成功后,引入导管采集门静脉系统肠系膜上静脉、门静脉左右支、门静脉主干、脾静脉及术前外周静脉等6部位血液,分别检测血浆氨、血小板和胰岛素含量,并进行对比分析。结果15例患者均成功完成6部位静脉采血及检测。血浆氨浓度以肠系膜上静脉最高,脾静脉和术前外周静脉最低(两组间差异无统计学意义),其余3部位(门静脉左右支及主干)间差异无统计学意义。血小板含量在6部位间差异无统计学意义。胰岛素浓度以脾静脉最高,术前外周静脉最低,其余4部位(肠系膜上静脉、门静脉左右支及主干)间差异无统计学意义。结论TIPS术中自门静脉系统不同部位采血用于肝脏相关血液成分检测安全可行,可作为有TIPS指征门静脉高压症患者临床基础研究方法。门静脉高压症患者门静脉左右支及主干内血浆氨、血小板和胰岛素含量无显著差异。

Objective To make a preliminary study on the distribution of important liver-related blood components in portal vein system in decompensated cirrhosis patients in order to provide valuable for the research about the effect of transjugular intrahepatic portosystemic shunt(TIPS)on the distribution of these components.Methods The clinical data of 15 patients with hepatitis B cirrhosis complicated by portal hypertension and upper gastrointestinal bleeding were retrospectively analyzed.The patients included 10 males and 5 females,with a mean age of 54.5 years.After puncturing of portal main trunk,or its left or right branch,succeeded during the performance of TIPS,the catheter was inserted into the portal vein system to separately collect blood sampling in superior mesenteric vein,left and right branches of portal vein,main portal vein and splenic vein,and preoperative blood sampling in peripheral vein was also conducted.The plasma ammonia,platelet and insulin contents were tested separately,the results were compared between different sites.Results The blood sampling and testing in six sites were successfully accomplished in all the 15 patients.The concentration of plasma ammonia was highest in superior mesenteric vein,which was lowest in splenic vein and preoperative peripheral vein(no significant difference existed between the two groups),and the difference in concentration of plasma ammonia between each other among the remaining three sites(left branch,right branch and main trunk of portal vein)was not statistically significant.There was no statistically significant difference in platelet count between each other among the six sites.The insulin concentration was highest in splenic vein and lowest in preoperative peripheral vein,and no statistically significant difference in insulin concentration existed between each other among the remaining four sites(superior mesenteric vein,and left branch,right branch,main trunk of portal vein).Conclusion It is feasible and safe to collect blood sampling from various parts of portal vein system for testing of important liver-related blood components during TIPS procedure.This technique can be used as a basic clinical research method for patients with portal hypertension who has TIPS indications.No significant differences in the contents of plasma ammonia,platelets and insulin exist between each other among the left branch,right branch and main trunk of portal vein in patients with portal hypertension。