经颈静脉肝内门体静脉分流术对脾切除术后门静脉高压患者治疗的有效性与安全性

摘要

Objective:To explore the effects and safety of transjugular intrahepatic portosystemic shunt (TIPS) on patients with portal hypertension after splenectomy.Methods:Sixty-eight patients with portal hypertension after splenectomy undergoing TIPS during May 2005 to May 2010 in Department of Radiation of Air Force General Hospital of PLA were enrolled into case group,and those patients with portal hypertension undergoing TIPS alone were recruited as control group.And eventually,we will analyze the success rate of operation,liver function,count ofplatelets and portal pressure before and after undergoing operation,and the adverse events between these two groups.Results:The success rates of operation in case and control groups were 97.06％ (66/68) and 100％(68/68) respectively,with statistical significance (xG0.04,P=0.15).The liver function and counts of platelets in these two groups before and after undergoing operation were not statistically significantly different (P＞0.05),however the counts of platelets in these groups decreased to be 45.4±8.6 and 59.4±15.8,the differences in each group was statistical significant (P＜0.05).The ALB in case group decreased to be 29.8±6.3,with statistical significance (P＜0.05).The portal pressure in these two groups decreased to be 27.3±5.4 and 28.5±4.3,the differences in each group was statistical significant (P＜0.05).After follow-up of 12-60 months,the failure rate of shunt in case group was higher than that of control group (22.73％ vs.8.82％,P=0.04),and the rate of remaining adverse evets were not statistical significant.Conclusion:TIPS in treating patients with portal hypertension after splenectomy obtain expected efficacy,however the failure rate of shunt after operation should be controlled cautiously when this operation option is considered.%目的:分析经颈静脉肝内门体静脉分流术(transjugular intrahepatic portosystemic shunt,TIPS)对行脾切除术后的门静脉高压治疗的有效性与安全性.方法:选取2005年5月至2010年5月于空军总医院放射介入科接受TIPS治疗的68名行脾切除术的门静脉高压患者为病例组,以同期接受TIPS治疗的未行脾切除术的门静脉高压患者68例为对照组,分析比较两组患者的手术成功率、治疗前后肝功能、血小板及门静脉压力的变化情况,并记录两组患者不良事件的发生情况.结果:病例组TIPS成功率为97.06％(66/68),对照组TIPS成功率为100％(68/68),两组比较差异无统计学意义(x2=0.04,P=0.15);两组患者手术前、后肝功能及血小板计数比较差异无统计学意义;病例组与对照组术后PLT计数分别降至45.4±8.6,59.4±15.8,差异有统计学意义(P＜0.05);病例组术后ALB降至29.8±6.3,差异有统计学意义(P＜0.05);两组患者手术前后门静脉压力比较无统计学差异,术后病例组与对照组分别降至27.3±5.4,28.5±4.3,差异有统计学意义(P＜0.05);随访观察12～60个月,病例组分流道失效率病例组高于对照组(22.73％ vs.8.82％,P=0.04),再出血率及肝性脑病发生率比较,差异无统计学意义.结论:已行脾断流术的患者接受TIPS治疗,仍可获得满意的临床疗效,但术后发生分流道失效的风险较高,因此临床应用时应注意前瞻性预防,以获得较满意的效益安全比.