经颈静脉直接肝内门体分流术治疗肝硬化顽固性腹腔积液效果及其影响因素

Effect of transjugular direct intrahepatic portosystemic shunt for treating refractory ascites in liver cirrhosis patients and impact factors

目的观察经颈静脉直接肝内门体分流术(DIPS)治疗肝硬化顽固性腹腔积液(RA)的效果及其影响因素。方法回顾性分析45例接受经颈静脉DIPS治疗的肝硬化RA患者,观察手术成功率及手术相关并发症。于DIPS次日开始随访12个月,比较术前与术后3、6、12个月实验室检查(白蛋白、总胆红素、凝血酶原时间、血氨)、门体静脉压力梯度(PSG)、Child-Pugh评分及分级、RA缓解率、肝性脑病(HE)发生率、分流道通畅率和生存率等指标;以单因素及多因素logistic回归分析观察术后3个月RA未缓解的影响因素。结果DIPS成功率100%。随访期间患者生存率100%。术前与术后3、6、12个月之间,除凝血酶原时间外,其余指标差异均有统计学意义(P均<0.05)。术后6、12个月RA缓解率及分流道通畅率均高于术后3个月(P均<0.05),术后3、6与12个月间HE发生率差异无统计学意义(P=0.607)。Child-Pugh评分、总胆红素、血氨为DIPS术后3个月RA未缓解的影响因素(P均<0.05),其中Child-Pugh评分为独立影响因素(P<0.05)。结论经颈静脉DIPS治疗肝硬化RA安全、有效;Child-Pugh评分是DIPS术后3个月RA未缓解的独立影响因素。

Objective To observe the effect of transjugular direct intrahepatic portosystemic shunt(DIPS)for treating refractory ascites(RA)in patients with liver cirrhosis and impact factors.Methods Data of 45 liver cirrhosis RA patients who underwent DIPS were retrospectively analyzed.The success rate of DIPS and relative complications were observed.The patients were followed up from the next day of DIPS for 12 months.Laboratory indexes,including albumin,total bilirubin,prothrombin time and serum ammonia,as well as portal pressure gradient(PSG),Child-Pugh scoring and grading,RA remission rate,incidence of hepatic encephalopathy(HE),shunt patency rate and survival rate were compared before and 3,6,12 months after DIPS.Then univariate and multivariate logistic regression analysis were used to explore the impact factors of non-remission of RA 3 months after DIPS.Results The success rate of DIPS was 100%.All patients were followed up,and the 12-month survival rate was 100%.Except for prothrombin time,significant differences of the other indicators were found between before and 3,6,12 months after DIPS(all P<0.05).The RA remission rate and shunt patency rate 6 and 12 months after DIPS were both higher than that 3 months after DIPS(all P<0.05),while the incidence of HE were not significant different among 3,6,and 12 months after DIPS(P=0.607).Child-Pugh score,total bilirubin and serum ammonia were all impact factors of non-remission of RA 3 months after DIPS(all P<0.05),and Child-Pugh score was the independent impact factor of non-remission of RA 3 months after DIPS(P<0.05).Conclusion Transjugular DIPS was safe and effective for treatment of cirrhotic RA.Child-Pugh score was the impact factor of non-remission of RA 3 months after DIPS.