经颈静脉肝内门体分流术治疗老年肝硬化门静脉高压病人的长期疗效分析

doi:10.3969/j.issn.1003-9198.2021.07.013

摘要/Abstract

摘要： 目的评价经颈静脉肝内门体分流术(TIPS)治疗老年肝硬化门静脉高压病人的安全性及长期临床疗效。方法收集2014年1月至2017年1月本中心88例因出血和(或)腹水接受TIPS 治疗的老年肝硬化门静脉高压病人的临床资料。回顾性分析手术前后血生化指标的变化情况;随访腹水缓解、复发出血、支架功能障碍、肝性脑病的发生情况及病人生存状况。采用Kaplan-Meier曲线计算术后累计发生率,采用COX回归分析术后死亡的影响因素。结果 88例病人手术成功率为100%,术后门静脉压力较术前明显降低[(18.77±5.89) cmH₂O 比(32.83±6.82) cmH₂O,P＜0.01]。术后总胆红素水平及Child-Pugh评分短期升高,1年恢复至基线水平。术后1、2、3年累计再出血率分别为6.2%、8.2%、11.2%;术后6个月腹水缓解率为81.5%;术后3、6、12、24、36个月累计肝性脑病发生率分别为17.2%、19.8%、22.6%、27.4%、31.3%;术后1、2、3年累计支架通畅率分别为93.3%、86.3%、79.1%,累计生存率分别为82.2%、75.5%、68.3%。COX多因素回归显示,系统终末期肝病模型(model for end-stage liver disease, MELD)评分(HR=1.24,95%CI:1.07～1.44,P=0.004),Child-Pugh分级(HR=2.63,95%CI:1.06～6.53,P=0.037)和合并基础疾病(HR=5.96,95%CI:2.16～16.44,P=0.001)是病人死亡的独立危险因素。结论 TIPS是治疗老年肝硬化门静脉高压并发症安全、有效的方法;MELD评分、Child-Pugh分级和合并基础疾病是病人术后死亡的独立影响因素。

关键词: 老年人, 肝硬化, 经颈静脉肝内门体分流术, 高血压, 门静脉

Abstract: Objective To evaluate the safety and long-term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of cirrhosis and portal hypertension in the eldely patients . Methods The clinical data of 88 elderly patients with cirrhosis and portal hypertension who received TIPS in our hospital because of bleeding or ascites from January 2014 to January 2017 were selected and analyzed retrospectively. The changes of the levels of biochemical indexes before and after TIPS were observed. The remission of ascites, recurrent bleeding, stent dysfunction, hepatic encephalopathy and survival were followed up. Kaplan-Meier method was used to analyze the postoperative rate.Cox regression was used to analyze the influencing factors of the postoperative mortality. Results The technical success rate of TIPS was 100%. The level of portal vein pressure decreased significantly after the operation (32.83±6.82 cmH₂O vs 18.77±5.89 cmH₂O, P<0.01). The level of total bilirubin and Child-Pugh score were increased in a short term, and then returned to baseline at 1 year after operation. The Cumulative rebleeding rate was 6.2%,8.2%,11.2% in 1, 2, 3 years after TIPS respectively. The ascites remission rate after 6 months was 81.5%,and the cumulative incidence of hepatic encephalopathy was 17.2%,19.8%,22.6%,27.4%,31.3% in 3, 6, 12, 24, 36 months after TIPS respectively. 1, 2, 3 years after the operation,the patency rate of stent was 93.3%, 86.3%, 79.1%, and the cumulative survival rate was 82.2%,75.5%,68.3% respectively. Cox multivariate regression showed that model for end-stage liver disease (MELD) score (HR=1.24, 95% CI: 1.07-1.44, P=0.004), Child Pugh classification (HR=2.63,95%CI:1.06-6.53,P=0.037)and combined basic diseases (HR=5.96,95%CI:2.16-16.44,P=0.001) were independent risk factors for death. Conclusions TIPS is a safe and effective method in the treatment of the elderly patients with cirrhosis and portal hypertension.MELD score, Child Pugh classification and the combination of basic diseases are the independent factors that affect the postoperative death of the patients.

Key words: aged, liver cirrhosis, transjugular intrahepatic portasystemic shunt, hypertension, portal

中图分类号:

R 575.2

黄山, 姚欣, 周昊, 陈雪玲, 汤善宏, 杨国栋, 秦建平. 经颈静脉肝内门体分流术治疗老年肝硬化门静脉高压病人的长期疗效分析[J]. 实用老年医学, 2021, 35(7): 713-717.

HUANG Shan, YAO Xin, ZHOU Hao, CHEN Xue-ling, TANG Shan-hong, QIN Jian-ping. Long-term clinical efficacy of transjugular intrahepatic portosystemic shunt in elderly patients with cirrhosis and portal hypertension[J]. Practical Geriatrics, 2021, 35(7): 713-717.

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