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

Abstract

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

CLC Number:

R 575.2

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.

References

[1] 中华人民共和国民政部. 2019年社会服务发展统计公报 [EB/OL]. (2020-09-08), http://www.mca.gov.cn/article/sj/tjgb/202009/20200900029333.shtml.
[2] CARRIER P, DEBETTE-GRATIEN M, JACQUES J, et al. Cirrhotic patients and older people [J]. World J Hepatol, 2019, 11(9): 663-677.
[3] 中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南[J]. 中华肝脏病杂志,2019, 27(8): 582-593.
[4] 秦建平,唐文,汤善宏,等. 改良经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压症[J]. 中华消化杂志,2014, 34(1):33-36.
[5] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会消化内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志,2016, 55(1):57-72.
[6] 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南 [J]. 中华肝脏病杂志, 2017, 25(9): 664-677.
[7] TENG D, ZUO H, LIU L, et al. Long-term clinical outcomes in patients with viral hepatitis related liver cirrhosis after transjugular intrahepatic portosystemic shunt treatment [J]. Virol J, 2018, 15(1): 151.
[8] EUROPEAN Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis [J]. J Hepatol, 2018, 69(2): 406-460.
[9] LI Y, WANG F, CHEN X, et al. Short outcome comparison of elderly patients versus nonelderly patients treated with transjugular intrahepatic portosystemic stent shunt: A propensity score matched cohort study [J]. Medicine: Baltimore, 2017, 96(29): e7551.
[10] BOSCH J, IWAKIRI Y. The portal hypertension syndrome: etiology, classification, relevance, and animal models [J]. Hepatol Int, 2018, 12(Suppl 1): 1-10.
[11] BERCU Z L, FISCHMAN A M, KIM E, et al. TIPS for Refractory Ascites: A 6-Year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts [J]. Am J Roentgenol, 2015, 204(3): 654-661.
[12] ADLAKHA N, RUSSO M W. Outcomes after transjugular intrahepatic portosystemic shunt in cirrhotic patients 70 years and older [J]. J Clin Med, 2020, 9(2): 381-390.
[13] SURAWEERA D, JIMENEZ M, VIRAMONTES M, et al. Age-related morbidity and mortality after transjugular intrahepatic portosystemic shunts [J]. J Clin Gastroenterol, 2017, 51(4): 360-363.
[14] ASCHA M, ABUQAYYAS S, HANOUNEH I, et al. Predictors of mortality after transjugular portosystemic shunt [J]. World J Hepatol, 2016, 8(11): 520-529.
[15] PARVINIAN A, SHAH K D, COUTURE P M, et al. Older patient age may predict early mortality after transjugular intrahepatic portosystemic shunt creation in individuals at intermediate risk [J]. J Vasc Interv Radiol, 2013, 24(7): 941-946.
[16] SAAD N, RUDE M K, DARCY M, et al. Older age is associated with increased early mortality after transjugular intrahepatic portosystemic shunt [J]. Ann Hepatol, 2016, 15(2): 215-221.

Long-term clinical efficacy of transjugular intrahepatic portosystemic shunt in elderly patients with cirrhosis and portal hypertension

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