摘要
目的探讨成人门静脉海绵样变的治疗方法及效果。方法回顾性分析2011年4月至2021年4月在郑州大学第一附属医院就诊并且随访资料完整并接受侵入性治疗的65例成人门静脉海绵样变患者的临床资料,根据患者治疗方法的不同将其分为经颈静脉肝内门腔静脉分流术(TIPS)组24例,脾-肺固定组11例,脾切除断流组22例,套扎组8例,采用Kaplan-Meier生存曲线和Log-rank检验比较4组患者肝性脑病发生时间和再出血时间的差异。结果4组患者的性别、年龄、术前血清AST、血清总胆红素、血清白蛋白及肝功能分级差异均无统计学意义(均P>0.05)。TIPS组术后半年、1、3年肝性脑病的发生率分别为33.3%±9.6%、46.5%±10.3%、64.4%±13.1%,肝性脑病的发生时间与其他3组比较差异具有统计学意义(χ^(2)=31.191,P=0.000)。TIPS组有3例患者在术后半年内出现上消化道出血,与脾-肺固定组再出血发生时间相比差异具有统计学意义(χ^(2)=7.542,P=0.006)。结论治疗门静脉海绵样变方法较多,应根据患者的病因、临床症状及梗阻部位选择个体化的治疗方案。
Objective To investigate the clinical treatment options for cavernous transformation of portal vein(CTPV).Methods Data of 65 CTPV patients receiving invasive treatment and followed up at the First Affiliated Hospital of Zhengzhou University between Apr 2011 and Apr 2021 were collected.Patients were divided into four groups based on different treatment option,24 patients were treated with transjugular intrahepatic portosystemic stent-shunt(TIPS)and 11 patients with splenopneumopexy,while 22 patients underwent splenectomy and devascularization,8 were treated by endoscopic variceal ligation.The difference of postoperative upper gastrointestinal bleeding and hepatic encephalopathy between the four groups were analyzed,Results There were no difference between four groups in sex,age,preoperative serum aspartate aminotransferase,total bilirubin,albuminand Child-Turcotte-Pugh grade.The incidence of hepatic encephalopathy in the TIPS group was 33.3%±9.6%、46.5%±10.3%and 64.4%±13.1%in half year,1 year,and 3 years,respectively.Postoperative hepatic encephalopathy rate was higher in TIPS group(χ^(2)=31.191,P=0.000).Three patients in the TIPS group developed upper gastrointestinal hemorrhage within 6 months after the operation,and postoperative upper gastrointestinal bleeding rate was higher in splenopneumopexy group(χ^(2)=7.542,P=0.006),Conclusion The clinical treatment options for CTPV patients are complicated,we should make individual treatment options depend on the etiology,clinical symptoms and site of blood flow obstruction.
作者
李林
党晓卫
李路豪
李素新
王培举
沈东启
刘胜炎
Lin Li;Xiaowei Dang;Luhao Li;Suxin Li;Peiju Wang;Dongqi Shen;Shengyan Liu(Department of Hepatopancreatobiliary Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2022年第6期410-413,共4页
Chinese Journal of General Surgery
关键词
高血压
门静脉
门体分流术
经颈静脉肝内
脾切除术
Hypertension,portal
Portasystennic shunt,tanjugular intrahepatic
Splenectomy
