本文選題：經(jīng)頸靜脈肝內(nèi)門體分流術(shù) + 食管胃底靜脈曲張破裂出血�。� 參考：《南京大學》2014年碩士論文

【摘要】：背景和目的：門靜脈血栓(PVT)是指血栓形成于門靜脈主干及其分支,伴或不伴腸系膜上靜脈/脾靜脈血栓形成。PVT是肝硬化進程中相當常見的并發(fā)癥,但我們對肝硬化合并PVT自然病程和治療方面研究不足,缺乏共識。肝硬化并發(fā)食管胃底靜脈曲張破裂出血(EGVB)是嚴重的臨床危重事件,單次出血死亡率達到20%-30%。一般認為,合并PVT的肝硬化EGVB患者預后更差,但對其治療尚無共識。有研究認為經(jīng)頸靜脈肝內(nèi)門體分流術(shù)(TIPS)可再通因血栓造成狹窄或堵塞的門靜脈系統(tǒng),減輕門脈高壓,治療相關(guān)并發(fā)癥,但針對合并PVT的肝硬化患者,TIPS預防EGVB的療效尚不清楚。本研究目的是初步評價TIPS對合并PVT的肝硬化患者預防EGVB的臨床療效。資料及方法：回顧性研究了南京市鼓樓醫(yī)院消化科,從2008年8月至2013年12月對32例有EGVB病史,且合并PVT的肝硬化患者的臨床和隨訪資料。主要研究內(nèi)容包括：TIPS治療患者術(shù)前和術(shù)后門體靜脈壓力梯度(PSG)變化、再出血率、分流道失功率、肝性腦病(HE)發(fā)生率及生存率。結(jié)果： (1)總體患者手術(shù)成功率為86.5%(32/37),無手術(shù)相關(guān)的重大并發(fā)癥及死亡事件發(fā)生。 (2)平均PSG從術(shù)前21.6±4.1mm Hg降至術(shù)后14.2±5.2mm Hg(P=0.000),PSG降幅為35.5%±17.9%。 (3)術(shù)后1年和2年再出血率分別為12.5%、50.8%。 (4)術(shù)后1年和2年分流道失功率分別為9.4%、32.0%。 (5)術(shù)后HE發(fā)生率為40.6%(13/32),均發(fā)生在術(shù)后1年內(nèi)。(6)術(shù)后1年和2年生存率分別為79.1%、73.4%。結(jié)論：初步研究顯示,在二級預防合并PVT的肝硬化患者EGVB中,TIPS可能降低再出血率和提高生存率,并有滿意的成功率和安全性。但術(shù)后較高的肝性腦病發(fā)生率應引起重視。
[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 鹵4.1mm Hg preoperatively to 14.2 鹵5.2mm Hg 0.000g / kg postoperatively. The decrease was 35.5% 鹵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.
【學位授予單位】：南京大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R575.2

【共引文獻】

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