TIPS方案对肝硬化合并门静脉血栓患者血管再通及生存率

Effects of TIPS on Vascular Recanalization and Survival Rate in Patients With Liver Cirrhosis Complicating Portal Venous Thrombosis

目的探讨经颈静脉肝内门体静脉分流术(TIPS)方案对肝硬化合并门静脉血栓患者血管再通及生存率的影响。方法回顾性分析110例肝硬化合并门静脉血栓患者,对其进行TIPS,术后对其进行半年随访;根据手术结果,分析成功患者术后血管再通、曲张静脉缓解和再发出血情况,统计直至随访终点时患者生存死亡情况。结果患者TIPS治疗后手术成功患者有93例,手术失败患者有17例,手术成功率为84.55%。手术成功患者术前有85例门静脉主干血栓,术后再通率为94.12%;伴有门静脉左支血栓患者共30例,术后再通率为26.67%;38例伴有门静脉右支血栓,术后再通率为73.68%;47例伴有肠系膜上静脉血栓,术后均得到缓解。手术成功者术后缓解率高于手术失败者(P<0.05)。手术失败患者有7例门静脉主干血栓,7例门静脉左、右支血栓,7例肠系膜上静脉血栓,术后直至随访结束均未缓解。手术成功患者术后出血率为7.53%;随访终点共13例患者曲张静脉未缓解,总缓解率为86.02%。手术失败患者总出血率为52.94%;直至随访终点患者曲张静脉未缓解。手术成功患者曲张静脉缓解率高于手术失败者,再发出血率低于手术失败者(P<0.05)。患者共有16例死亡,总生存率为85.45%。手术成功者生存率高于手术失败者(P<0.05)。结论TIPS方案是肝硬化合并门静脉血栓患者的重要治疗方法,疗效得到肯定,临床中根据适应症合理选择手术可有效减少术后出血,提高血管再通率及生存率,推荐使用。

Objective To investigate the effects of transjugular intrahepatic portosystemic shunt(TIPS)on vascular recanalization and survival rate in patients with liver cirrhosis complicating portal venous thrombosis.Methods 110 patients with liver cirrhosis complicating portal venous thrombosis receiving TIPS were enrolled.All patients received half year follow-up.Then the postoperative blood vessel recanalization,varicose vein relief,rebleeding,survival and death were recorded.Results After TIPS treatment,93 cases were successful and 17 cases failed.The success rate was 84.55%.Results:85 patients with successful operation had main portal vein thrombosis before operation,and the recanalization rate was 94.12%;30 patients with left portal vein thrombosis,and the recanalization rate was 26.67%;38 patients with right portal vein thrombosis,and the recanalization rate was 73.68%;47 patients with superior mesenteric vein thrombosis,and all patients were relieved after operation.The remission rate of patients with successful operation was higher than that of patients with failure(P<0.05).There were 7 cases of main portal vein thrombosis,7 cases of left and right portal vein thrombosis,and 7 cases of superior mesenteric vein thrombosis in patients with failed operation.The postoperative bleeding rate was 7.53%in patients with successful operation,and the total remission rate was 86.02%.The total bleeding rate of patients with failed operation was 52.94%,and the varicose vein did not relieve until the end of follow-up.The remission rate of varicose vein in patients with successful operation was higher than that in patients with failed operation,and the re bleeding rate was lower than that in patients with failed operation(P<0.05).A total of 16 patients died,the overall survival rate was 85.45%.The survival rate of successful operation was higher than that of failure operation(P<0.05).Conclusion TIPS is an important treatment method for patients with cirrhosis combined with portal vein thrombosis.In clinical practice,reasonable selection of surgery based on indications can effectively reduce postoperative bleeding,improve the rate of vascular recanalization and survival rate,which is worthy of recommendation.