TIPS预防肝硬化合并门静脉血栓患者食管胃底静脉曲张再出血的疗效研究

发布时间：2018-04-25 21:49

本文选题：经颈静脉肝内门体分流术 + 食管胃底静脉曲张破裂出血　；参考：《南京大学》2014年硕士论文

【摘要】：背景和目的：门静脉血栓(PVT)是指血栓形成于门静脉主干及其分支,伴或不伴肠系膜上静脉/脾静脉血栓形成。PVT是肝硬化进程中相当常见的并发症,但我们对肝硬化合并PVT自然病程和治疗方面研究不足,缺乏共识。肝硬化并发食管胃底静脉曲张破裂出血(EGVB)是严重的临床危重事件,单次出血死亡率达到20%-30%。一般认为,合并PVT的肝硬化EGVB患者预后更差,但对其治疗尚无共识。有研究认为经颈静脉肝内门体分流术(TIPS)可再通因血栓造成狭窄或堵塞的门静脉系统,减轻门脉高压,治疗相关并发症,但针对合并PVT的肝硬化患者,TIPS预防EGVB的疗效尚不清楚。本研究目的是初步评价TIPS对合并PVT的肝硬化患者预防EGVB的临床疗效。资料及方法：回顾性研究了南京市鼓楼医院消化科,从2008年8月至2013年12月对32例有EGVB病史,且合并PVT的肝硬化患者的临床和随访资料。主要研究内容包括：TIPS治疗患者术前和术后门体静脉压力梯度(PSG)变化、再出血率、分流道失功率、肝性脑病(HE)发生率及生存率。结果： (1)总体患者手术成功率为86.5%(32/37),无手术相关的重大并发症及死亡事件发生。 (2)平均PSG从术前21.6±4.1mm Hg降至术后14.2±5.2mm Hg(P=0.000),PSG降幅为35.5%±17.9%。 (3)术后1年和2年再出血率分别为12.5%、50.8%。 (4)术后1年和2年分流道失功率分别为9.4%、32.0%。 (5)术后HE发生率为40.6%(13/32),均发生在术后1年内。(6)术后1年和2年生存率分别为79.1%、73.4%。结论：初步研究显示,在二级预防合并PVT的肝硬化患者EGVB中,TIPS可能降低再出血率和提高生存率,并有满意的成功率和安全性。但术后较高的肝性脑病发生率应引起重视。
[Abstract]:Background & objective: portal vein thrombosis (PVT) refers to thrombosis in the main portal vein and its branches, with or without superior mesenteric / splenic vein thrombosis. PVT is a very common complication in the progression of liver cirrhosis. However, there is a lack of consensus on the natural course and treatment of cirrhosis associated with PVT. Cirrhosis complicated with esophageal variceal variceal hemorrhage (EGVB) is a severe clinical event with a single bleeding death rate of 20 to 30. It is generally believed that the prognosis of patients with liver cirrhosis EGVB with PVT is worse, but there is no consensus on its treatment. Some studies suggest that transhepatic portosystemic shunt (TIPS) can recanalize the portal vein system caused by thrombosis, alleviate portal hypertension and treat related complications. However, the efficacy of tips in preventing EGVB in patients with PVT is not clear. The aim of this study was to evaluate the clinical efficacy of TIPS in preventing EGVB in cirrhotic patients with PVT. Materials and methods: the clinical and follow-up data of 32 patients with EGVB who had history of EGVB and complicated with PVT were studied retrospectively in the Department of Digestive Diseases, Gulou Hospital of Nanjing City from August 2008 to December 2013. The main contents of the study included the changes of portal vein pressure gradient (PSG), rebleeding rate, shunt power, incidence and survival rate of hepatic encephalopathy (HEH) before and after TIPS treatment. Results: 1) the overall success rate of operation was 86.5 / 37. There were no major complications and death events associated with surgery. (2) the mean PSG decreased from 21.6 卤4.1mm Hg preoperatively to 14.2 卤5.2mm Hg 0.000g / kg postoperatively. The decrease was 35.5% 卤17.9%. The rate of rebleeding in 1 year and 2 years after operation was 12.5% and 50.8%, respectively. The power loss of shunt in 1 and 2 years after operation was 9.4 and 32.0, respectively. (5) the incidence of postoperative HE was 40.6 / 32, which occurred within 1 year.) the 1 year and 2 year survival rates were 79.1% and 73.4%, respectively. Conclusion: the preliminary study shows that tips may reduce the rate of rebleeding and improve the survival rate in patients with liver cirrhosis with secondary prevention of PVT and has satisfactory success rate and safety. However, the high incidence of hepatic encephalopathy after operation should be paid attention to.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2

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