摘要
目的:探究肝硬化门静脉高压患者经颈静脉肝内门体静脉分流术(TIPS)后门静脉分支远端血栓形成影响因素及其对预后的影响.方法:选取南方医科大学南方医院2021年1月～2023年1月行TIPS的300例肝硬化门静脉高压患者,根据术后6个月内门静脉分支远端血栓形成发生与否分为血栓组与非血栓组.对比两组临床资料,多因素Logistic回归分析TIPS术后门静脉分支远端血栓形成的相关因素.对比两组术后6个月预后情况.结果:术后门静脉分支远端血栓形成发生率10.67％(32/300).血栓组年龄、术前3d内血浆D-二聚体(D-D)、总胆固醇(TC)、低密度脂蛋白(LDL)水平、门静脉主干直径、门脉左支直径、Child-Pugh分级A级比例、门静脉流速与非血栓组对比差异均有统计学意义(P＜0.05);多因素Logistic回归分析显示,高龄、LDL水平升高、门脉左支直径增大是TIPS术后门静脉分支远端血栓形成的危险因素,Child-Pugh分级为A级为保护因素(P＜0.05).血栓组TIPS术后6个月TIPS支架通畅率、肝性脑病、肝功能损伤及死亡发生率与非血栓组对比无统计学意义(P＞0.05).结论:肝硬化门静脉高压TIPS术后门静脉分支远端血栓形成与年龄、术前LDL、Child-Pugh分级、门脉左支直径相关,但对患者术后6个月TIPS支架通畅率、肝性脑病、肝功能损伤及死亡发生率没有影响.
Abstract
Objective:To explore the influencing factors of distal portal vein thrombosis and its effect on prognosis in patients with cirrhotic portal hypertension after transjugular intrahepatic portosystemic shunt(TIPS).Methods:300 patients with cirrhotic portal hypertension who underwent TIPS in Nanfang Hospital of Southern Medical University from January 2021 to January 2023 were selected,patients were divided into thrombosis group and non-thrombosis group according to the occurrence of distal thrombosis of portal vein branches within 6 months after operation.Compared the clinical data of two groups,the related factors of distal portal vein thrombosis after TIPS were analyzed by Multivariate Logistic regression.The prognosis in two groups at 6 months after operation was compared.Results:The incidence of distal portal vein thrombosis was 10.67％(32/300)after operation.There were statistically significant differences in the proportion of age,plasma D-dimer(D-D),total cholesterol(TC),low density lipoprotein(LDL)levels within 3 days before operation,main portal vein diameter,left portal vein diameter,Child-Pugh grade A ratio,portal vein flow rate between thrombosis group and non-thrombosis group(P＜0.05).Multivariate Logistic regression analysis showed that advanced age,elevated LDL levels,and increased diameter of the left portal vein diameter were risk factors for distal portal vein thrombosis after TIPS,while Child Pugh grade A was protective factor(P＜0.05).There was no significant difference in TIPS stent patency rate,hepatic encephalopathy,liver function injury and mortality rate between thrombosis group and non-thrombosis group at 6 months after TIPS(P＞0.05).Conclusions:The distal portal vein thrombosis after TIPS in cirrhotic portal hypertension is related to age,preoperative LDL,Child-Pugh classification and diameter of left portal vein,but has no effect on the 6-month postoperative TIPS stent patency rate,hepatic encephalopathy,liver function injury,and mortality rate in patients.
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