经颈静脉肝内门体分流术治疗脾切除术后静脉曲张再出血

目的评价经颈静脉肝内门体分流术(TIPS)治疗脾切除术后静脉曲张再出血的疗效及随访结果。方法回顾性分析中山大学附属第三医院2010年12月至2016年12月间,因脾切除术后静脉曲张再出血而接受了TIPS治疗的患者33例,观察手术成功率、并发症及临床随访结果。结果 33例患者TIPS手术成功31例(93.9%),失败2例。成功的患者其门体压力梯度(PPG)从分流前平均23.5±5.9 mmHg下降至分流后平均12.1±3.3 mmHg(P<0.05)。除1例患者因感染性休克于围手术期死亡外,对手术成功的30例进行了随访(中位随访时间62.5个月)。10例发生分流道失功,其中4例再发消化道出血伴1例死亡、1例再发大量腹水、1例并发急性肠系膜静脉血栓、肠梗阻。10例出现显性肝性脑病,其中4例轻度发作经药物治疗后好转、1例反复发生3期肝性脑病行分流道限流术、5例术后死于肝功能衰竭。随访期间除上述6例死亡以外,另有2例因肺部疾病及1例因肝细胞癌死亡。余患者随访期间分流道通畅且未再发生静脉曲张破裂出血。术后第6个月随访结果显示,30例患者的平均血清白蛋白、血清总胆红素较术前改善(P<0.05)。结论 TIPS是治疗脾切除术后静脉曲张再出血安全且有效的方式。

Transjugular intrahepatic portosystemic shunt for variceal rebleeding after splenectomy

ObjectiveTo evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for variceal rebleeding after splenectomy. Methods33 patients with variceal rebleeding after splenectomy underwent TIPS in our hospitalfrom December 2010 to December 2016 were enrolled in this retrospective study. Success rates, efficacy, and complications were evaluated. ResultsTIPS was successfully performed in 31 patients and failed in 2. Mean portosystemic pressure gradient (PPG) fell from 23.5±5.9 mmHg to 12.1±3.3 mmHg after successful TIPS procedure (P<0.05). One patient died due to septic shock during perioperative period. The median follow-up of 62.5 months in 30 cases. Shunt dysfunction appeared in 10 cases with4 rebleeding and 1 of them died due to rebleeding, while 1 case suffered massive ascites and 1 case suffered acute mesenteric vein thrombosis followed by intestinal obstruction. Overt hepatic encephalopathy appeared in 10 cases. Four of them recovered after receiving medical treatment and 1 experienced grade 3 hepatic encephalopathy, while the other 5 died from liver failure due to severe cirrhosis. There were 2 more death due to pulmonary disease and 1 death due to hepatocellular carcinoma after procedure. The other patients remained asymptomatic and shunt patency. The average level of serum total bilirubin and serum albumin 6 months after procedure were better than those before procedure (P<0.05). ConclusionsTIPS is safe and effective on controlling variceal rebleeding after splenectomy in portal hypertension.