经颈静脉肝内门体分流术治疗特发性非肝硬化门静脉高压消化道大出血的临床疗效

Clinical efficacy of transjugular intrahepatic portosystemic shunt for gastrointestinal hemorrhage in patients with idiopathic noncirrhotic portal hypertension

目的:探讨经颈静脉肝内门体分流术(TIPS)治疗特发性非肝硬化门静脉高压(INCPH)消化道大出血的中远期疗效。方法:回顾性分析2013 年3月至2018年7月,在郑州大学第一附属医院、安阳市第五人民医院、运城市中心医院经病理诊断确诊的13例INCPH消化道大出血患者,其中男性5例、女性8例,所有患者均接受TIPS治疗,收集每例患者的临床资料及随访情况,分析其一般资料、术后病死率、再出血率、分流道失功率及肝性脑病发生率。结果:13例INCPH患者全部完成TIPS,年龄33~59(45±8)岁,TIPS术前肝静脉压力梯度(HVPG)由20.0~26.0(22.6±1.9)mmHg(1 mmHg=0.133 kPa)降至术后的8.0~14.0(9.4±3.2)mmHg。随访时间为31~53(44±7)个月,1例患者术后27个月死于肝功能衰竭,术后12个月、24个月、36个月肝性脑病累积出现1例(1/13)、1例(1/13)、1例(1/13),术后12个月、24个月、36个月支架再狭窄累积出现2例(2/13)、3例(3/13)、3例(3/13),发现门静脉血栓2例(2/13),无原发性肝癌发生。结论:TIPS治疗INCPH消化道大出血是安全有效的,中远期疗效确切。

Objective To explore the medium-long term efficacy of transjugular intrahepatic portosystemic shunt(TIPS)for gastrointestinal hemorrhage in patients with idiopathic non-cirrhotic portal hypertension(INCPH).Methods From March 2013 to July 2018,clinical data of 13 INCPH patients,including 5 males,8 females,with gastrointestinal hemorrhage were retrospectively analyzed,who were diagnosed at the First Affiliated Hospital of Zhengzhou University,Anyang Fifth People′s Hospital and Yuncheng Central Hospital.All patients received TIPS treatment.The general information,postoperative survival rate,the incidence of rebleeding,shunt dysfunction rate,and incidence of hepatic encephalopathy were analyzed.Results All 13 patients with INCPH completed TIPS successfully with an average age of 45±8(33 to 59)years.The hepatic venous pressure gradient(HVPG)decreased from 20.0-26.0(22.6±1.9)mmHg before procedure to 8.0-14.0(9.4±3.2)mmHg after.The median follow-up time was 44±7(31 to 53)months.One patient died of liver failure 27 months after TIPS.Hepatic encephalopathy occurred cumulatively in 1 case(1/13),1 case(1/13)and 1 case(1/13)in 12,24 and 36 months after TIPS.Stent restenosis occurred cumulatively in 2 cases(2/13),3 cases(3/13)and 3 cases(3/13)in 12,24 and 36 months after TIPS.Portal vein thrombosis occurred cumulatively in 2 cases(2/13),and no primary liver cancer developed.Conclusions TIPS is safe and effective in the treatment of INCPH with gastrointestinal bleeding with favorable medium-long term outcome.