经颈静脉肝内门体静脉分流术对肝硬化门静脉高压症患者门静脉直径及远期疗效的影响

The impacts of transjugular intrahepatic portosystemic shunt on the portal vein diameter and long-term outcome of liver cirrhotic patients with portal hypertension

目的探究经颈静脉肝内门体静脉分流术(TIPS)对肝硬化门静脉高压症(PHT)患者门静脉直径(PVD)及远期疗效的影响。方法选择2017年1月—2020年1月保定市第二中心医院收治的100例肝硬化PHT患者,利用随机数字表法分为对照组(50例,采用贲门周围血管离断术治疗)与研究组(50例,采用TIPS治疗),收集患者的临床资料并比较两组患者的肝脏血流动力学、肝功能及远期疗效。结果术前1 d,两组肝硬化PHT患者的PVD、门静脉血流量(PVF)、脾静脉内径(SVD)、脾静脉血流量(SVF)、门静脉流速(PVV)、脾静脉流速(SVV)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)及总胆红素(TBil)比较差异均无统计学意义(P>0.05);术后7 d,PVD[(1.15±0.22)cm vs(1.53±0.32)cm]、PVF[(774.45±101.28)mL vs(845.33±120.39)mL]、SVD[(1.17±0.21)cm vs(1.32±0.27)cm]、SVF[(304.47±63.38)mL vs(400.01±74.12)mL]、ALT[(38.45±8.61)U/L vs(50.26±10.05)U/L]、AST[(39.18±8.97)U/L vs(48.51±10.13)U/L]、TBil[(28.19±6.08)μmol/L vs(39.53±8.96)μmol/L]均降低(P<0.05),PVV[(45.69±9.98)cm/s vs(30.08±6.57)cm/s]及SVV[(24.76±6.02)cm/s vs(18.96±4.04)cm/s]均升高(P<0.05),且上述指标研究组改善更为明显(P<0.05)。两组肝硬化PHT患者的存活率随着术后时间的增加而降低,术后3年研究组的存活率明显高于对照组(P<0.05),并且,术后3年研究组的不良事件总发生率低于对照组,但两组之间差异无统计学意义(P>0.05)。结论TIPS治疗肝硬化PHT效果确切,可明显改善肝硬化PHT患者肝脏血流动力学及肝功能,对患者的远期疗效好。

Objective To investigate the impacts of transjugular intrahepatic portosystemic shunt(TIPS)on portal vein diameter(PVD)and long-term outcome of patients with liver cirrhosis and portal hypertension(PHT).Methods A total of 100 patients with liver cirrhosis and PHT admitted from January 2017 to January 2020 were randomly grouped into a control group(50 cases,treated with pericardial revascularization)and a study group(50 cases,treated with TIPS)using a random number table method.The clinical data of all patients were collected and the liver hemodynamics,liver function,and long-term efficacy of the treatments in both groups of patients were compared.Results One day before surgery,there were no obvious differences in PVD,portal venous blood flow(PVF),splenic venous inner diameter(SVD),splenic venous blood flow(SVF),portal venous flow velocity(PVV),splenic venous flow velocity(SVV),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and total bilirubin(TBIL)between the two groups(P>0.05).At 7d after surgery,The PVD[(1.15±0.22)cm vs(1.53±0.32)cm],PVF[(774.45±101.28)mL vs(845.33±120.39)mL],SVD[(1.17±0.21)cm vs(1.32±0.27)cm],SVF[(304.47±63.38)mL vs(400.01±74.12)mL],ALT[(38.45±8.61)U/L vs(50.26±10.05)U/L],AST[(39.18±8.97)U/L vs(48.51±10.13)U/L],and TBil[(28.19±6.08)μmol/L vs(39.53±8.96)μmol/L]were decreased and improved more in the study group when compared with those in the control group(P<0.05),whereas PVV[(45.69±9.98)cm/s vs(30.08±6.57)cm/s]and SVV[(24.76±6.02)cm/s vs(18.96±4.04)cm/s]were increased(P<0.05).The survival rate of PHT patients with liver cirrhosis in both groups decreased with the increase of postoperative time,and the survival rate in the study group was obviously higher than that in the control group in 3 years after surgery(P<0.05),moreover,the total incidence of adverse events in the study group was lower than that in the control group in three years after surgery,however,there was no obvious difference between the two groups(P>0.05).Conclusion TIPS is effective in the treatment of PHT in patients with liver cirrhosis,and may obviously improve liver hemodynamics and liver function in patients with liver cirrhosis and PHT,with a good long-term effect on the patients.