摘要
目的 旨在评估经颈静脉肝内门体分流术(TIPS)治疗原发性胆汁性胆管炎合并门静脉高压的长期疗效。方法 回顾性纳入2015年1月1日—2021年8月30日南京大学医学院附属鼓楼医院收治的接受TIPS治疗的102例患者,并分为原发性胆汁性胆管炎(PBC)组(n=41)及病毒性肝炎肝硬化组(n=81)。收集患者入院初的血常规、肝肾功能、凝血功能、门静脉血栓、肝性脑病、接受TIPS治疗的病因,术前的门静脉压力及手术使用的支架情况,同时计算Child-Pugh评分。随访资料收集术后上消化道再出血、支架失功、肝性脑病及生存预后相关资料,并进行分析。符合正态分布的计量资料2组间比较采用独立样本t检验;偏态分布的计量资料2组间比较采用Mann-Whitney U检验。计数资料2组间比较采用χ~2检验。采用Kaplan-Meier法进行生存分析,采用Log-rank检验比较生存差异。结果 PBC组和病毒性肝炎肝硬化组患者门静脉压力较术前降低的中位百分比分别为33.00%和35.00%,2组比较差异无统计学意义(P>0.05)。随访结束时,PBC组和病毒性肝炎肝硬化组在支架失功率(14.63%vs 24.69%)、上消化道再出血率(17.07%vs 24.69%)、显性肝性脑病发生率(12.20%vs 7.41%)和疾病相关死亡率(14.63%vs 9.88%)方面的差异均无统计学意义(χ~2值分别为1.642、0.917、0.289、0.229,P值均>0.05)。结论 TIPS治疗伴有门静脉高压的PBC患者,可达到治疗病毒性肝炎肝硬化所致门静脉高压的同等疗效,可有效降低门静脉高压,且不增加并发症发生率及疾病相关死亡率,是一种安全有效的治疗方法。
Objective To investigate the long-term efficacy of transjugular intrahepatic portosystemic shunt(TIPS) in the treatment of primary biliary cholangitis(PBC) with portal hypertension.Methods A retrospective analysis was performed for 102 patients who received TIPS in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2015 to August 2021,and these patients were divided into PBC group with 41 patients and viral hepatitis cirrhosis group with 81 patients.Related indicators were collected,including routine blood test results,liver and renal function,coagulation function,portal vein thrombosis,hepatic encephalopathy,and etiology of TIPS treatment shortly after admission,preoperative portal venous pressure,and stents used in surgery,and Child-Pugh score was calculated.Follow-up data were collected and analyzed,including postoperative upper gastrointestinal rebleeding,stent dysfunction,hepatic encephalopathy,and the data on survival and prognosis.The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups;the chi-square test was used for comparison of categorical data between two groups.The Kaplan-Meier method was used for survival analysis,and the log-rank test was used for survival difference analysis.Results In the PBC group and the viral hepatitis cirrhosis group,the median percentage of reduction in portal venous pressure after surgery was 33.00% and 35.00%,respectively,and there was no significant difference between the two groups(P>0.05).At the end of follow-up,there were no significant differences between the PBC group and the viral hepatitis cirrhosis group in stent dysfunction rate(14.63% vs 24.69%,χ~2=1.642,P>0.05),upper gastrointestinal rebleeding rate(17.07% vs 24.69%,χ~2=0.917,P>0.05),the incidence rate of overt hepatic encephalopathy(12.20% vs 7.41%,χ~2=0.289,P>0.05),and disease-specific death rate(14.63% vs 9.88%,χ~2=0.229,P>0.05).Conclusion For PBC patients with portal hypertension,TIPS can achieve the same efficacy as the treatment of portal hypertension caused by viral hepatitis cirrhosis and can also effectively reduce portal hypertension without increasing the incidence rate of complications and disease-specific death rate.Therefore,it is a safe and effective treatment method.
作者
童雅茹
尹晓春
张玮
孙畅
张明
诸葛宇征
TONG Yaru;YIN Xiaochun;ZHANG Wei;SUN Chang;ZHANG Ming;ZHUGE Yuzheng(Department of Gastroenterology,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2023年第2期333-338,共6页
Journal of Clinical Hepatology
基金
国家自然科学基金(82100652)。
关键词
肝硬化
胆汁性
肝炎
病毒性
人
肝硬化
门体分流术
经颈静脉肝内
高血压
门静脉
Liver Cirrhosis,Biliary
Hepatitis,Viral,Human
Liver Cirrhosis
Portasystemic Shunt,Transjugular Intrahepatic
Hypertension,Portal
