经颈静脉肝内门体分流术对酒精性肝硬化导致门静脉高压的治疗效果与安全性分析

目的分析经颈静脉肝内门体分流术(TIPS)治疗酒精性肝硬化导致门静脉高压的有效性及安全性。方法回顾性总结2006年6月至2011年6月本院30例接受TIPS治疗的酒精性肝硬化导致门静脉高压的患者资料,记录术前及术后门静脉压力、腹水、脾功能亢进、肝功能等指标。随访终点为术后2 a,观察术后并发症包括消化道再出血、支架堵塞、腹水及肝性脑病发生情况,并分析肝性脑病发生与患者临床参数的关系。穿刺前、后门静脉压力差别采用配对t检验分析;Kaplan-Meier方法用于术后临床参数与肝性脑病发生相关性分析。结果 TIPS手术成功率为100%(30/30),门静脉压力术前(37.27±2.52)cm H2O降为术后(24.6±2.58)cm H2O,差异具有统计学意义(P0.05)。术后2 a内,消化道再出血率为3.3%(1/30);腹水治疗有效率达88.9%(16/18);支架狭窄发生率为6.7%(2/30);肝性脑病发生率为40%(12/30)。Kaplan-Meier分析发现患者术前Child-Pugh分级与术后肝性脑病发生密切相关(P=0.04)。结论 TIPS是治疗酒精性肝硬化门静脉高压相关并发症安全有效的微创方法,术前ChildPugh分级是影响患者肝性脑病发生的重要因素。

Clinical effect and safety of TIPS in treatment of portal hypertension due to alcoholic cirrhosis

ObjectiveTo evaluate the clinical effect and safety of transjugular intrahepatic portosystemic shunt （TIPS） in the treatment of portal hypertension due to alcoholic cirrhosis. MethodsA retrospective analysis was performed on the clinical data of 30 patients with portal hypertension due to alcoholic cirrhosis who received TIPS in our hospital; the clinical indices before and after TIPS were recorded to evaluate portal venous pressure, ascites, hypersplenism, and liver function. Postoperative follow-up was performed for 2 years to detect the complications including recurrent variceal bleeding, in-stent restenosis, ascites, and hepatic encephalopathy, and the relationship between the incidence of hepatic encephalopathy and clinical indices was analyzed. The change in portal venous pressure after puncture was evaluated by paired t test; the Kaplan-Meier method was used to analyze the correlation between clinical indices and the incidence of hepatic encephalopathy after TIPS. ResultsThe success rate of TIPS was 100% （30/30）. The portal venous pressure was significantly decreased from 37.27±2.52 cm H2O before operation to 24.6±2.58 cm H2O after operation （P〈0.05）. Within 2 years after TIPS, the recurrence rate of variceal bleeding was 3.3% （1/30）; the response rate in ascites treatment was 88.9% （16/18）; the incidence of in-stent restenosis was 6.7% （2/30）; the incidence of hepatic encephalopathy was 40% （12/30）. The Kaplan-Meier analysis indicated that the Child-Pugh classification before TIPS was significantly correlated with the postoperative incidence of hepatic encephalopathy （P=0.04）. ConclusionTIPS is an effective and safe minimally invasive therapy for portal hypertension-related complications in patients with alcoholic cirrhosis. Preoperative Child-Pugh classification is an important influential factor for the postoperative incidence of hepatic encephalopathy.