经颈静脉肝内门体分流术治疗老年肝硬化门静脉高压症的疗效及对血流动力学的影响

摘要

Objective To investigate the clinical effect of transjugular intrahepatic portosystemic shunt(TIPS)on the treatment of elderly patients with liver cirrhosis induced portal hypertension(PHT)and hemodynamics. Methods A total of 158 patients with liver cirrhosis induced PHT enrolled into depart-ment of hepatobiliary surgery in Nanjing Drum Tower hospital from 2013 till now and underwent TIPS were collected into our study. The portal system hemodynamics,surgical treatment,liver function and other labo-ratory indicators were recorded and compared before and after operation. Results At one month after op-eration,the portosystemic pressure gradient 18. 51 ± 3. 09(mmHg),portal vein diameter(PVD)1. 22 ± 0. 51(cm),portal vein flow(PVF)816. 9 ± 214. 8(ml),singular value decomposition(SVD)1. 09 ± 0. 27 (cm),splenic vein flow(SVF)355. 4 ± 18. 39(ml)had decreased compared with those before operation (P < 0. 05). The portal venous flow velocity(PVV)46. 27 ± 20. 65(cm/ s)and splenic vein flow velocity (SVV)25. 26 ± 4. 17(cm/ s)had increased compared with those before operation(P < 0. 05). The liver function [total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate transaminase(AST)]had in-creased compared with those before operation(P < 0. 05). At the sixth month after operation,ATL and AST decreased gradually compared with those before treatment(P < 0. 05). Serum albumin(ALB)had no significant changes before and after operation(P > 0. 05). The plasma levels of plasma renin activity (PRA),angiotensin II(ATII)and endothelin(ET)had significantly decreased after one month post opera-tive,and the difference was statistically significant(P < 0. 05). The clinical efficacy was evaluated in 113 cases(71. 52％)as the effective,40 cases(25. 32％)as the improved and 5 cases(3. 16％)as the ineffec-tive. Conclusion TIPS can be used in the treatment of elderly patients with cirrhosis caused PHT,with the advantages of minimally invasive,reliable operation,while postoperative complications should be paid attention.%目的 探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗老年肝硬化门静脉高压症(portal hypertension,PHT)的临床效果及对血流动力学的影响.方法 肝硬化PHT老年病人158例,均采用TIPS治疗,分析病人手术前后门脉系统血流动力学、临床疗效和肝功能等指标的变化.结果 术后1个月病人门体压力梯度为(18.51±3.09)mm-Hg、门静脉直径(portal vein diameter,PVD)为(1.22±0.51)cm、门静脉血流量(portal vein flow,PVF)为(816.9±214.8)ml、脾静脉内径(splenic vein diameter,SVD)为(1.09±0.27)cm、脾静脉血流量(splenic vein flow,SVF)为(355.4±183.9)ml,与术前比较均降低(P<0.05);门静脉流速(portal venous flow velocity,PVV)为(46.27±20.65)cm/s、脾静脉流速(splenic vein flow velocity,SVV)为(25.26±4.17)cm/s,与术前比较升高(P<0.05).术后1个月病人总胆红素(total biliru-bin,TBIL)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate transaminase,AST)与术前比较升高(P<0.05),术后6个月ATL、AST降低,并且低于术前水平(P<0.05),血清白蛋白(albumin,ALB)水平手术前后变化不明显(P>0.05).手术后1个月病人的血浆肾素活度(plasma renin activity,PRA)、血管紧张素Ⅱ(AngiotensinⅡ,ATⅡ)和内皮素(endo-thelin,ET)水平与术前比较明显降低(P<0.05).显效113例(71.52％),好转40例(25.32％),无效5例(3.16％).结论 TIPS手术治疗老年肝硬化致PHT快速有效,具有微创、手术效果可靠的优点,但术后应关注并发症的发生.