發(fā)布時間：2018-10-17 14:26

【摘要】：背景:經(jīng)頸靜脈肝內(nèi)門體分流術(shù)(transjugular intrahepatic portosystemic shunt,TIPS)歷經(jīng)20余年的發(fā)展,已經(jīng)成為控制門脈高壓出血、難治性腹水的一種治療選擇。但術(shù)后仍存在一些并發(fā)癥的風(fēng)險,如肝性腦病,分流道失效等。肝門脈血流指數(shù)能夠反映門脈血流的相對多少,其在TIPS術(shù)后的變化尚未有文獻報道。ICG(吲哚菁綠)試驗?zāi)壳笆菄H上公認的評價肝臟儲備功能的一項可靠的方法,其在TIPS術(shù)中的應(yīng)用尚未有文獻報道。因此,TIPS術(shù)后肝門脈血流指數(shù)和ICG的變化及與TIPS術(shù)后并發(fā)癥的關(guān)系值得研究和探討。目的:觀察TIPS術(shù)治療食道胃底靜脈曲張破裂出血和難治性腹水的臨床療效以及術(shù)后肝性腦病,分流道失效等并發(fā)癥的發(fā)生,分析比較各項臨床指標(肝功能,血氨,門脈血流指數(shù),ICGR15)在TIPS術(shù)后的變化。方法:前瞻性研究2015年11月-2016年12月于浙江大學(xué)附屬第一醫(yī)院行TIPS術(shù)治療的肝硬化門脈高壓患者14例,術(shù)前完善血常規(guī),肝功能,血氨,肝門脈ECT,ICG試驗,TIPS術(shù)中及支架置入成功后分別測門靜脈壓力,術(shù)后第二天復(fù)查血常規(guī),肝功能,血氨,3天內(nèi)復(fù)查肝門脈ECT,ICG試驗,分析比較各項臨床指標的變化。同時術(shù)后隨訪2周-12月,觀察術(shù)后并發(fā)癥的發(fā)生。采用SPSS18.0進行統(tǒng)計分析,P0.05視為有顯著性差異。結(jié)果:14例行TIPS術(shù)的患者均手術(shù)成功,其中13例胃底食道靜脈曲張破裂出血患者住院期間未再出血,另1例難治性腹水患者術(shù)后腹水顯著減少。門脈壓力由TIPS術(shù)前的31.36±3.20mmHg下降至術(shù)后的22.79±4.21mmHg(P0.01),門脈血流指數(shù)由 42.69±11.84%下降至 18.69±9.24%(P0.01)。ALT 由 18.67±10.42U/L 上升至86.17±80.46U/L(P0.05),AST 由 24.08±9.27U/L 上升至 86.67±71.43U/L(P0.05),TBIL 由 19.50±10.28umol/L 上升至 41.93±34.23umol/L(P0.05),血氨由36.93±14.81umol/L 上升至 84.36±56.35umol/L(P0.05),ICGR15 由 17.5±8.7%上升至27.2±7.6%(P0.05),而膽堿酯酶,白蛋白,白細胞,血紅蛋白,血小板在TIPS術(shù)后無顯著變化(P0.05)。一名患者于術(shù)后2周發(fā)生肝性腦病,另一名患者術(shù)后半年因分流道失效再次出現(xiàn)胃底食道靜脈曲張破裂出血。結(jié)論:TIPS術(shù)后患者門脈壓力較術(shù)前顯著下降,對防治胃底食道靜脈曲張破裂出血和頑固性腹水近期臨床療效較明顯,但術(shù)后患者肝功能受到一定程度損害,肝臟儲備功能及門脈血流指數(shù)較術(shù)前下降,遠期可以出現(xiàn)肝性腦病,分流道失效等并發(fā)癥。
[Abstract]:Background: Transjugular intrahepatic portosystemic shunt (transjugular intrahepatic portosystemic shunt,TIPS) has been developed for more than 20 years and has become a therapeutic option for controlling portal hypertension hemorrhage and refractory ascites. However, there are still some risks of complications, such as hepatic encephalopathy, shunt failure and so on. The hepatic portal blood flow index can reflect the relative amount of portal blood flow. The changes of portal blood flow after TIPS have not been reported in the literature. The. ICG (indocyanine green (. ICG () test is an internationally accepted and reliable method for evaluating liver reserve function. Its application in TIPS surgery has not been reported. Therefore, the changes of hepatic portal blood flow index and ICG after TIPS and their relationship with postoperative complications of TIPS are worth studying and discussing. Objective: to observe the clinical efficacy of TIPS in the treatment of esophageal variceal bleeding and refractory ascites, and to analyze and compare the clinical parameters (liver function, blood ammonia), and the occurrence of postoperative complications such as hepatic encephalopathy and shunt failure. Changes of portal blood flow index (ICGR15) after TIPS. Methods: from November 2015 to December 2016, 14 patients with hepatic cirrhosis and portal hypertension underwent TIPS from November 2015 to December 2016. Portal vein ECT,ICG test, portal vein pressure were measured during TIPS operation and stent implantation, blood routine examination, liver function, blood ammonia and hepatic portal ECT,ICG test were performed on the second day after operation, and the changes of clinical indexes were analyzed and compared. At the same time, follow up 2 weeks to 12 months, observe the occurrence of postoperative complications. Using SPSS18.0 statistical analysis, P0.05 as a significant difference. Results: all the 14 patients who underwent TIPS were successfully operated. 13 patients with esophageal variceal bleeding did not rebleed during hospitalization, and 1 patient with refractory ascites decreased ascites significantly after operation. 闂ㄨ剦鍘嬪姏鐢盩IPS鏈墠鐨，

本文編號：2276975