经颈静脉肝内门静脉左支、右支门腔分流术治疗肝硬化门脉高压症的临床研究

发布时间：2018-06-04 11:42

本文选题：经颈内静脉肝内门体分流术 + 门脉高压症　；参考：《泸州医学院》2014年硕士论文

【摘要】：目的：探讨经颈静脉肝内门腔分流术（TransjugularIntrahepatic Portosystemic Shunt,TIPS）中建立门静脉左支门腔分流道与右支门腔分流道对肝硬化门脉高压症患者术后肝性脑病发生的差异。方法：回顾性分析我院2012年3月-2014年3月收治37例门脉高压所致上消化道出血，并行TIPS术患者。其中经颈静脉肝内门静脉左支门腔分流术患者组18例（左支组）和经颈静脉肝内门静脉右支门腔分流术组（对照组）19例。比较两组门静脉属支血氨浓度差异及门静脉压力梯度（portal pressure gradient PPG）情况；技术成功率及术后6月分流道通畅率；对比术后第1天及术后第7天外周肘静脉血氨浓度；术后6月肝性脑病发生率和生存率的差异等。结果：分流前，，两组门静脉系统中对应同一属支血氨浓度有差异，差异无统计学意义（P0.05）；门静脉系统中不同属支间血氨浓度有差异，其中，肠系膜上静脉高于门静脉左支、右支，高于脾静脉，门静脉右支高于左支，且差异均具有统计学意义（P0.05）。两组技术成功率均为100%。分流后，各组中PPG术后与术前比较差异均有统计学意义（P0.05），术后两组间无统计学意义（P0.05）。术后第1天肘静脉血氨浓度，左支组和对照组分别为(78.3+17.6)umol/L、(102.7+41.6)umol/L(P=0.024)；术后第7天肘静脉血氨浓度(57.8+12.4)umol/L、(85.2+38.7)umol/L(P=0.007)。左支组术后第7天血氨浓度较术后第1天下降，差异有统计学意义（P0.001）；对照组术后第7天血氨浓度较术后第1日下降，差异无统计学意义（P=0.069）。术后随访6个月，两组均未发生再出血，无死亡病例，分流道均通畅，组间生存率差异无统计学意义。左支组2例，对照组9例发生肝性脑病经药物治疗缓解。结论：肝硬化门脉高压症患者门静脉系统中各属支血氨浓度存在差异,提示TIPS术中门静脉左支、右支的选择可能会影响患者术后肝性脑病的发生。选择门静脉左支作为TIPS的分流道,是安全可行的，可降低肝硬化门脉高压症患者术后血氨的上升幅度和肝性脑病的发生率，较选择门静脉右支作为TIPS的分流道有一定的优势，但在分流道通畅率、再出血率、生存率等方面二者无明显差异。
[Abstract]:Objective: to investigate the difference of hepatic encephalopathy in patients with cirrhosis and portal hypertension after transjugular intrahepatic Portosystemic shunt (Transjugular intrahepatic Portosystemic shunt). Methods: from March 2012 to March 2014, 37 patients with upper gastrointestinal hemorrhage caused by portal hypertension were treated in our hospital and treated with TIPS. Among them, 18 patients (left branch group) and 19 patients (control group) underwent transjugular intrahepatic portal vein shunt (left branch group) and right portal vein shunt group (control group 19 cases). The blood ammonia concentration of portal vein branch and portal vein pressure gradient portal pressure gradient PPG) were compared between the two groups, the technical success rate and the patency rate of shunt duct in 6 months after operation were compared, and the blood ammonia concentration of elbow vein on the 1st and 7th day after operation was compared. Difference in incidence and survival rate of hepatic encephalopathy at 6 months after operation. Results: before shunt, there was significant difference in blood ammonia concentration between the two groups corresponding to the same branch of portal vein, but there was no significant difference in blood ammonia concentration between different branches of portal vein, in which the superior mesenteric vein was higher than the left branch of portal vein and the right branch. The right branch of portal vein was higher than the left branch, and the difference was statistically significant (P 0.05). The technical success rate of both groups was 100%. After shunt, there was significant difference between PPG and preoperation in each group (P 0.05), but there was no significant difference between the two groups after operation (P 0.05). On the first day after operation, the concentration of ammonia in the left branch group and the control group were 78.36 渭 mol / L ~ 102.7 渭 mol / L ~ (-1) ~ 102.7 渭 mol / L ~ (-1) P ~ (0.024), respectively, and on the 7th day after operation, the blood ammonia concentration of the cubital vein was 57.8 ~ (12.4) 渭 m / L ~ (-1) O / L ~ + ~ (85. 2) umoll / L ~ (-1) P ~ (0.007). In the left branch group, the blood ammonia concentration decreased on the 7th day after operation compared with that on the first day after operation, and the difference was statistically significant (P 0.001), while in the control group, the blood ammonia concentration on the 7th day after operation was lower than that on the first day after operation, and the difference was not statistically significant. After 6 months follow-up, there was no rebleeding, no death, no shunt and no significant difference in survival rate between the two groups. There were 2 cases in the left branch group and 9 cases in the control group. Conclusion: the concentration of ammonia in portal vein system of patients with portal hypertension is different, which suggests that the choice of left and right branches of portal vein during TIPS may influence the occurrence of hepatic encephalopathy after operation. It is safe and feasible to select the left portal vein as the shunt of TIPS. It can reduce the increase of blood ammonia and the incidence of hepatic encephalopathy in patients with cirrhosis and portal hypertension. It has some advantages over the right portal vein as the shunt of TIPS. However, there was no significant difference in shunt patency rate, rebleeding rate and survival rate between the two groups.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.21

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