肝硬化自发性脾肾分流的治疗与预后分析

Management and prognosis of spontaneous splenorenal shunt in liver cirrhosis

目的:分析肝硬化自发性脾肾分流(spontaneous splenorenal shunt,SSRS)患者临床特点,对比不同治疗的效果及预后。方法:回顾性分析郑州大学第一附属医院2016至2022年肝硬化合并SSRS患者资料,根据治疗方式分为A组保守治疗、B组单纯栓塞、C组经颈静脉肝内门腔静脉分流术(TIPS)联合栓塞、D组肝移植,比较不同治疗组肝功能变化、不良事件发生率及生存状态。结果:SSRS直径与血氨正相关(R=0.478),与门静脉直径负相关(R=-0.301),SSRS直径增加是消化道出血及腹水的保护因素,是肝性脑病的危险因素。A组处理后血氨降低、凝血酶原时间延长(P<0.05),B组血氨降低、白蛋白升高(P<0.05),C组血红蛋白、胆红素升高(P<0.05),D组血氨、胆红素降低,白蛋白等升高(P<0.05);生存分析显示A、C组预后与肝功能相关,D组生存率优于其他(P<0.05)。结论:SSRS栓塞治疗安全有效,肝移植能改善患者生存状态,应根据患者症状、肝功能、分流道直径等选择个体化治疗方法。

Objective To analyze the clinical characteristics of patients with spontaneous splenorenal shunt(SSRS)in liver cirrhosis,and to compare the effects and prognosis of different treatments.Methods The data of cirrhotic patients with SSRS at the First Affiliated Hospital of Zhengzhou University between 2016-2022 were retrospectively analyzed.Patients were divided into Group A receiving conservative treatment,Group B by simple embolization,Group C undergoing TIPS combined with embolization,and Group D given liver transplantation.Life status,liver function changes,incidences of adverse events,and survival between groups were compared.Results SSRS diameter was positively correlated with blood ammonia(R=0.478)and negatively correlated with portal vein diameter(R=-0.301).SSRS diameter is a protective factor for gastrointestinal hemorrhage and ascites and a risk factor for hepatic encephalopathy;Blood ammonia decreased and prothrombin time prolonged after treatment in group A(P<0.05),blood ammonia decreased and albumin increased in group B(P<0.05).Hemoglobin and bilirubin increased in group C(P<0.05),blood ammonia and bilirubin decreased and platelets and albumin increased in group D(P<0.05);Survival analysis showed that the prognosis of groups A and C was related to liver function,and the survival rate of group D was the highest of all(P<0.05).Conclusions SSRS embolization is safe and effective,and liver transplantation improves patient survival.Individualized treatment should be selected based on patient symptoms,liver function,and shunt diameter.