门静脉分支选择对于经颈静脉肝内门体分流术治疗食管胃静脉曲张出血的疗效影响
|
摘要
目的探讨门静脉右支分流及左支分流对于经颈静脉肝内门体分流术(TIPS)治疗食管胃静脉曲张出血(EGVB)的疗效影响。方法回顾性分析68例接受TIPS治疗的EGVB患者临床资料,包括34例行穿刺门静脉右支建立分流道(门静脉右支组),34例行穿刺门静脉左支建立分流道(门静脉左支组),比较两组疗效差异。结果TIPS手术成功率100%。门静脉右支组患者术后6、12及24个月累积无消化道再出血率分别为80. 87%、76. 61%及69. 64%,而门静脉左支组分别为84. 87%、80. 83%及75. 44%(P=0. 67)。门静脉右支组患者术后6及12个月分流道累积通畅率分别为84. 58%及68. 34%,而门静脉左支组分别为90. 23%及83. 78%(P=0. 78)。门静脉右支组患者术后12及48个月累积生存率分别为90. 14%及72. 12%,而门静脉左支组分别为91. 08%及70. 06%,差异无统计学意义(P=0. 57)。门静脉右支组和门静脉左支组术后肝性脑病发生率分别为17. 65%和26. 47%,差异无统计学意义(P=0. 38)。结论门静脉分支选择对于经颈静脉肝内门体分流术治疗食管胃静脉曲张出血的疗效无影响。
Objective To investigate the effect of right portal shunt and left branch shunt on the treatment of esophagogastric varices bleeding( EGVB) by transjugular intrahepatic portosystemic shunt( TIPS). Methods The clinical data of 68 patients with EGVB who underwent TIPS were retrospectively analyzed,including 34 patients who underwent puncture of the right portal vein to establish a shunt( right portal vein group),and 34 patients underwent puncture of the left branch of the portal vein to establish a shunt( portal left branch). We compared the difference in efficacy between the two groups.Results The success rate of TIPS surgery was 100%. Patients with right portal vein group had cumulative gastrointestinal rebleeding rates of 80. 87%,76. 61%,and 69. 64% at 6,12,and 24 months after surgery,while the left portal vein group was 84. 87%,80. 83%,and 75. 44%,respectively( P = 0. 67). The cumulative patency rate of the portal vein in the right portal group was 84. 58% and 68. 34% at 6 and 12 months,respectively,and the left portal group was 90. 23% and 83. 78%( P = 0. 78). The cumulative survival rates of patients with right portal vein at 12 and 48 months were 90.14% and 72. 12%,respectively,and those with left portal vein were 91. 08% and 70. 06%,respectively,and the difference was not statistically significant( P = 0. 57). The incidence of hepatic encephalopathy in the right portal vein group and the left portal vein group was 17. 65% and 26. 47%,respectively,and the difference was not statistically significant( P =0. 38). Conclusion The choice of portal vein branch has no effect on the treatment of esophagogastric varices bleeding by jugular intrahepatic portosystemic shunt.
Objective To investigate the effect of right portal shunt and left branch shunt on the treatment of esophagogastric varices bleeding( EGVB) by transjugular intrahepatic portosystemic shunt( TIPS). Methods The clinical data of 68 patients with EGVB who underwent TIPS were retrospectively analyzed,including 34 patients who underwent puncture of the right portal vein to establish a shunt( right portal vein group),and 34 patients underwent puncture of the left branch of the portal vein to establish a shunt( portal left branch). We compared the difference in efficacy between the two groups.Results The success rate of TIPS surgery was 100%. Patients with right portal vein group had cumulative gastrointestinal rebleeding rates of 80. 87%,76. 61%,and 69. 64% at 6,12,and 24 months after surgery,while the left portal vein group was 84. 87%,80. 83%,and 75. 44%,respectively( P = 0. 67). The cumulative patency rate of the portal vein in the right portal group was 84. 58% and 68. 34% at 6 and 12 months,respectively,and the left portal group was 90. 23% and 83. 78%( P = 0. 78). The cumulative survival rates of patients with right portal vein at 12 and 48 months were 90.14% and 72. 12%,respectively,and those with left portal vein were 91. 08% and 70. 06%,respectively,and the difference was not statistically significant( P = 0. 57). The incidence of hepatic encephalopathy in the right portal vein group and the left portal vein group was 17. 65% and 26. 47%,respectively,and the difference was not statistically significant( P =0. 38). Conclusion The choice of portal vein branch has no effect on the treatment of esophagogastric varices bleeding by jugular intrahepatic portosystemic shunt.
引文
1 Bosch J,Abraldes JG,Groszmann R.Current management of portal hypertension[J].J Hepatol,2003,38 Suppl 1:S54-68.
2 Holster IL,Tjwa ET,Moelker A,et al.Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy+β-blocker for prevention of variceal rebleeding[J].Hepatology,2016,63:581-589.
3 Bai M,He CY,Qi XS,et al.Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt[J].World J Gastroenterol,2014,20:774-785.
4 Chen L,Xiao T,Chen W,et al.Outcomes of transjugular intrahepatic portosystemic shunt through the left branch vs.the right branch of the portal vein in advanced cirrhosis:a randomized trial[J].Liver Int,2009,29:1101-1109.
5郑晖,黄宁,黄兢姚,等.经颈静脉肝内门体分流术联合胃冠状静脉栓塞治疗食管胃底静脉曲张破裂出血[J].中国介入影像与治疗学,2016,13:85-89.
6陈辉,吕勇,王秋和,等.经颈静脉肝内门体分流术专家共识[J].临床肝胆病杂志,2017,33:1218-1228.
7 Qi X,Tian Y,Zhang W,et al.Covered TIPS for secondary prophylaxis of variceal bleeding in liver cirrhosis:A systematic review and meta-analysis of randomized controlled trials[J].Medicine(Baltimore),2016,95:e5680.
8唐世伟,赵新建,王忠敏,等.TIPS对比EBL治疗肝硬化食管静脉曲张出血Meta分析[J].介入放射学杂志,2016,25:761-765.
9马富权,李伟之,李培杰,等.经颈静脉肝内门体分流术中穿刺门静脉不同支对术后肝性脑病发生率影响的系统评价[J].中华放射学杂志,2017,51:202-205.
10 Qi XS,Bai M,Yang ZP,et al.Selection of a TIPS stent for management of portal hypertension in liver cirrhosis:an evidence-based review[J].World J Gastroenterol,2014,20:6470-6480.
11诸建国,陈肇一,吕春燕,等.门静脉左支分流降低术后肝性脑病的临床研究[J].中华肝脏病杂志,2002,10:38-41.
12 Mogicato G,Vautravers G,Meynaud-Collard P,et al.Blood flows in tributaries of the portal vein:anatomical and angiographic studies in normal beagle dogs[J].Anat Histol Embryol,2015,44:460-467.
13 Vilstrup H,Amodio P,Bajaj J,et al.Hepatic encephalopathy in chronic liver disease:2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J].J Hepatol,2014,61:642.
14 Xue H,Yuan J,Chao-Li Y,et al.Follow-up study of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension[J].Dig Dis Sci,2011,56:3350-3356.
2 Holster IL,Tjwa ET,Moelker A,et al.Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy+β-blocker for prevention of variceal rebleeding[J].Hepatology,2016,63:581-589.
3 Bai M,He CY,Qi XS,et al.Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt[J].World J Gastroenterol,2014,20:774-785.
4 Chen L,Xiao T,Chen W,et al.Outcomes of transjugular intrahepatic portosystemic shunt through the left branch vs.the right branch of the portal vein in advanced cirrhosis:a randomized trial[J].Liver Int,2009,29:1101-1109.
5郑晖,黄宁,黄兢姚,等.经颈静脉肝内门体分流术联合胃冠状静脉栓塞治疗食管胃底静脉曲张破裂出血[J].中国介入影像与治疗学,2016,13:85-89.
6陈辉,吕勇,王秋和,等.经颈静脉肝内门体分流术专家共识[J].临床肝胆病杂志,2017,33:1218-1228.
7 Qi X,Tian Y,Zhang W,et al.Covered TIPS for secondary prophylaxis of variceal bleeding in liver cirrhosis:A systematic review and meta-analysis of randomized controlled trials[J].Medicine(Baltimore),2016,95:e5680.
8唐世伟,赵新建,王忠敏,等.TIPS对比EBL治疗肝硬化食管静脉曲张出血Meta分析[J].介入放射学杂志,2016,25:761-765.
9马富权,李伟之,李培杰,等.经颈静脉肝内门体分流术中穿刺门静脉不同支对术后肝性脑病发生率影响的系统评价[J].中华放射学杂志,2017,51:202-205.
10 Qi XS,Bai M,Yang ZP,et al.Selection of a TIPS stent for management of portal hypertension in liver cirrhosis:an evidence-based review[J].World J Gastroenterol,2014,20:6470-6480.
11诸建国,陈肇一,吕春燕,等.门静脉左支分流降低术后肝性脑病的临床研究[J].中华肝脏病杂志,2002,10:38-41.
12 Mogicato G,Vautravers G,Meynaud-Collard P,et al.Blood flows in tributaries of the portal vein:anatomical and angiographic studies in normal beagle dogs[J].Anat Histol Embryol,2015,44:460-467.
13 Vilstrup H,Amodio P,Bajaj J,et al.Hepatic encephalopathy in chronic liver disease:2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J].J Hepatol,2014,61:642.
14 Xue H,Yuan J,Chao-Li Y,et al.Follow-up study of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension[J].Dig Dis Sci,2011,56:3350-3356.