肝硬化伴门静脉血栓经颈静脉肝内门体分流术后分流道失功能的影响因素分析

Analysis of influencing factors of shunt dysfunction after transjugular intrahepatic portosystemic shunt in liver cirrhosis accompanied with portal vein thrombosis

目的探讨肝硬化合并门静脉血栓(PVT)经颈静脉肝内门体分流术(TIPS)术后分流道的疗效。方法回顾性分析2015年1月至2018年5月收治的肝硬化伴PVT行TIPS术治疗患者44例,收集患者的临床基线资料,记录手术前后门静脉压力梯度(PVPG),术后随访3、6、12、18、24个月时分流道支架通畅情况,对影响因素进行单因素及多因素分析。结果44例均成功建立肝内门腔分流道,术后PVPG均较术前下降(P值均<0.01)。PVT行TIPS术后分流道狭窄率为18.2%(n=8),术后3、6、12、18、24个月累积分流道支架通畅率分别为95.5%、90.7%、90.7%、86.8%、74.4%。单因素分析显示糖尿病史、血小板水平及凝血酶原时间国际标准化比值与术后分流道失功能有关,多因素分析显示糖尿病史(P=0.007,OR=28.606)是术后分流道失功能的独立风险因素。结论肝硬化PVT行TIPS手术安全可行,可有效降低门静脉压力,糖尿病患者术后分流道失功能风险较高,临床上应加强对高危风险患者的防治干预。

Objective To investigate the efficacy of shunt after transjugular intrahepatic portosystemic shunt(TIPS)in liver cirrhosis accompanied with portal vein thrombosis(PVT).Methods Forty-four cases with liver cirrhosis accompanied with PVT who underwent TIPS treatment from January 2015 to May 2018 were retrospectively analyzed.Clinical baseline data of the patients were collected.Portal vein pressure gradient(PVPG)before and after the surgery was recorded.Shunt patency was observed at 3,6,12,18 and 24 months after the surgery.The influencing factors were determined by univariate and multivariate analysis.Results Transjugular intrahepatic portosystemic shunt was successfully established in all 44 cases.The postoperative PVPG was lower than preoperative(P<0.01).The shunt patency rate after TIPS in PVT was 18.2%(n=8).The cumulative shunt patency rates at 3,6,12,18,and 24 months after surgery were 95.5%,90.7%,90.7%,86.8%and 74.4%,respectively.Univariate analysis showed that diabetes history,platelet level and prothrombin time-international normalized ratio were associated with postoperative shunt dysfunction.Multivariate analysis showed that diabetes history(P=0.007,OR=28.606)was an independent risk factor for postoperative shunt dysfunction.Conclusion TIPS is a safe and feasible procedure,which can effectively reduce the portal pressure in liver cirrhosis accompanied with PVT.Diabetic patients have a higher risk of postoperative shunt dysfunction.Therefore,clinical intervention should be strengthened for high-risk patients.