TIPS治疗肝硬化门静脉血栓的临床疗效
Clinical efficacy of TIPS in the treatment of portal vein thrombosis in liver cirrhosis
陈永慧 1李智 2陈卫1
作者信息
- 1. 南京医科大学附属淮安第一医院介入科 江苏 淮安 223300
- 2. 苏州大学附属第一医院介入科 江苏 苏州 215006
- 折叠
摘要
目的 探讨经颈静脉肝内门体分流术(TIPS)治疗肝硬化合并门静脉血栓(PVT)的临床疗效.方法 选取 17例肝硬化合并PVT,并有食管胃底静脉曲张破裂出血患者,对其进行TIPS治疗,术后进行随访 6～25 个月(平均 16 个月).根据手术结果,分析手术治疗成功率、术后血管再通、曲张静脉缓解和再发出血情况.结果 17 例患者TIPS手术成功 14 例,成功率 82.3%.术前门静脉主干血栓 9 例,至随访结束 1 例未缓解,再通率 88.9%,门静脉主干伴有分支血管血栓 3 例,2 例部分缓解;2 例伴有肠系膜上静脉血栓,术后均得到缓解.3 例手术失败患者均未缓解.14 例手术成功患者术后 3 个月、6 个月再发出血分别为 1 例、2 例,出血率为 21.4%.术后 10 例曲张静脉转为轻度或消失,缓解率为76.9%.14 例手术成功患者 3 例术后发生肝性脑病,治疗后好转.所有患者无严重并发症发生.结论 TIPS对于抗凝治疗失败的PVT患者具有非常好的技术成功率及临床疗效,明显提高了门静脉再通率,减少了门静脉高压相关并发症,疗效肯定,可作为一线治疗方法.
Abstract
Objective To investigate the clinical effect of transjugular intrahepatic portosystemic shunt(TIPS)in the treat-ment of liver cirrhosis complicated with portal vein thrombosis.Methods A retrospective analysis was conducted on 14 patients with cirrhosis complicated with portal vein thrombosis,and TIPS was given to them.The patients were followed up for 6～25 months(with an average of 16 months)after surgery.According to the results of surgery,the success rate of surgery,postopera-tive vascular recanalization,varicose vein remission and rebleeding were analyzed.Results 14 out of 17 patients underwent TIPS surgery successfully,with a success rate of 82.3%.There were 9 cases of main venous thrombosis before surgery,and 1 case remained unresolved until the end of follow-up,with a recanalization rate of 88.9%.There were 3 cases of main portal vein thrombosis accompanied by branch vessels,and 2 cases were partially relieved.2 cases were accompanied by superior mesen-teric vein thrombosis,and all were relieved after surgery.All 3 patients who failed the surgery did not improve.14 successful pa-tients experienced recurrent bleeding at 3 and 6 months after surgery,with a bleeding rate of 21.4%.After surgery,10 cases of varicose veins turned mild or disappeared,with a remission rate of 76.9%.3 of the 14 successful patients developed hepatic en-cephalopathy after surgery,which improved after treatment.No serious complications occurred in all patients.Conclusion TIPS has a very good technical success rate and clinical efficacy for patients with portal vein thrombosis who have failed antico-agulation treatment.TIPS significantly improves the rate of portal vein recanalization and reduces complications related to portal hypertension.TIPS has a definite therapeutic effect,which can be used as a first-line treatment method.
关键词
经颈静脉肝内门体分流术/门静脉血栓/肝硬化门静脉高压/介入性,放射学Key words
Transjugular intrahepatic portosystemic shunt/Portal vein thrombosis/Cirrhotic portal hypertension/Interven-tional radiology引用本文复制引用
出版年
2024
NETL
NSTL
万方数据