经颈静脉肝内门体分流术对肝硬化合并严重门静脉血栓患者生存的影响

徐征国; 赵泳冰; 刘恩; 杨震; 杨仕明

doi:10.16016/j.1000-5404.201809054

您当前的位置：

首页 >

文章列表页 >

经颈静脉肝内门体分流术对肝硬化合并严重门静脉血栓患者生存的影响

临床医学 | 更新时间：2026-01-09

- 经颈静脉肝内门体分流术对肝硬化合并严重门静脉血栓患者生存的影响
- Transjugular intrahepatic portosystemic shunt for liver cirrhosis with severe portal thrombosis: survival outcome and its predictors
- 第三军医大学学报 2018年40卷第23期页码：2204-2210，封三
- 作者机构：
  
  400037 重庆, 陆军军医大学(第三军医大学)第二附属医院消化内科
- 作者简介：
  
  [ 杨仕明, E-mail:shimingyang@yahoo.com YANG Shiming, E-mail:shimingyang@yahoo.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201809054
  中图分类号： R543.6;R575.2;R615
- 收稿：2018-09-07，
  
  修回：2018-09-26，
  
  纸质出版：2018-12-15
- 稿件说明：
移动端阅览
徐征国, 赵泳冰, 刘恩, 等. 经颈静脉肝内门体分流术对肝硬化合并严重门静脉血栓患者生存的影响[J]. 第三军医大学学报, 2018,40(23):2204-2210，封三.

Zhengguo XU, Yongbing ZHAO, En LIU, et al. Transjugular intrahepatic portosystemic shunt for liver cirrhosis with severe portal thrombosis: survival outcome and its predictors[J]. Journal of Third Military Medical University, 2018, 40(23): 2204-2210，封三.
徐征国, 赵泳冰, 刘恩, 等. 经颈静脉肝内门体分流术对肝硬化合并严重门静脉血栓患者生存的影响[J]. 第三军医大学学报, 2018,40(23):2204-2210，封三. DOI： 10.16016/j.1000-5404.201809054.

Zhengguo XU, Yongbing ZHAO, En LIU, et al. Transjugular intrahepatic portosystemic shunt for liver cirrhosis with severe portal thrombosis: survival outcome and its predictors[J]. Journal of Third Military Medical University, 2018, 40(23): 2204-2210，封三. DOI： 10.16016/j.1000-5404.201809054.

摘要

目的

分析经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt

TIPS)用于治疗肝硬化合并严重门静脉血栓患者(portal vein thrombosis

PVT)的数据

了解其对生存的影响。

方法

回顾性分析2013年1月至2017年10月肝硬化合并门静脉系统严重非肿瘤性血栓行TIPS治疗的患者共44例

观察短期疗效(6个月)和长期疗效(1~3年)

同时通过经验总结及统计学分析得出生存预测因子和生存影响结局。

结果

44例患者TIPS治疗成功37例

手术成功率84%

术中无严重并发症

44例患者随访时间长达36个月

中位随访时间24个月。TIPS治疗成功组

大部分PVT再通

支架功能障碍3例

短期内(6个月)肝功有好转

2例死于肝癌

2例死于肝功能衰竭。TIPS失败组7例

门静脉血栓均无明显缓解

4例复发出血

其中2例死亡。统计分析得出:血管再通是生存的唯一预测因子

同时TIPS成功组生存率较失败组高。

结论

TIPS用于肝硬化合并严重门静脉血栓患者

使血管再通后能显著提高其生存率。

Abstract

Objective

To analyze the outcomes of patients with liver cirrhosis complicated by severe portal vein thrombosis (PVT) receiving transjugular intrahepatic portosystemic shunt (TIPS) and identify the predictors for the patients' survival.

Methods

We retrospectively analyzed the clinical data of 44 patients with liver cirrhosis complicated by severe non-neoplastic PVT undergoing TIPS between January

2013 and October

2017 to assess the short-term (6 months) and long-term (1~3 years) treatment efficacy. The survival outcomes of the patients and the predictors for the patient survival were analyzed.

Results

Among the 44 patients

TIPS was successfully completed in 37 patients (84%) without serious complications. The longest follow-up time of the patients was 36 months

and the median follow-up time was 24 months. In cases with successful TIPS

most of the PVT was revascularized

and stent dysfunction occurred in 3 cases. Within 6 months after the surgery

liver function was improved in most of the cases; 2 patients died due to liver cancer

and 2 due to liver failure. In the 7 cases with failed TIPS

no significant relief of portal vein thrombosis occurred after the surgery; 4 patients experienced recurrent bleeding

and 2 of them died. Statistical analysis showed that revascularization was the only predictor of patient survival

and the survival rate was higher in cases with successful TIPS than in cases with failed TIPS.

Conclusion

In patients with liver cirrhosis complicated by severe PVT

TIPS can significantly improve the survival rate after revascularization. Our results support the application of TIPS in such patients to improve their survival outcomes.

关键词

Keywords

references

DEBNATH C R, DEBNATH M R, ALAM M M, et al. Cirrhosis of liver and portal vein thrombosis-a review article[J]. Mymensingh Med J, 2014, 23(3): 606-608.

PARIKH S, SHAH R, KAPOOR P. Portal vein thrombosis[J]. Am J Med, 2010, 123(2): 111-119. DOI:10.1016/j.amjmed.2009.05.023.

AMITRANO L, GUARDASCIONE M A, BRANCACCIO V, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis[J]. J Hepatol, 2004, 40(5): 736-741. DOI: 10.1016/j.jhep.2004.01.001.

VALLA D C, CONDAT B, LEBREC D. Spectrum of portal vein thrombosis in the west[J]. J Gastroenterol Hepatol, 2002, 17(Suppl 3): S224-S227. DOI: 10.1046/j.1440-1746.17.s3.4.x.

VILLA E, CAMMC, MARIETTA M, et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis[J]. Gastroenterology, 2012, 143(5): 1253-1260.e4. DOI: 10.1053/j.gastro.2012.07.018.

QI X, HAN G, HE C, et al. CT features of non-malignantportal vein thrombosis: a pictorial review[J]. Clin Res HepatolGastroenterol, 2012, 36(6): 561-568. DOI: 10.1016/j.clinre.2012.05.021.

PONZIANI F R, ZOCCO M A, GARCOVICH M, et al. What we should know about portal vein thrombosis in cirrhotic patients: a changing perspective[J]. World J Gastroenterol, 2012, 18(36): 5014-5020. DOI: 10.3748/wjg.v18.i36.5014.

吴勤, 楚金东, 金波, 等.肝硬化后门静脉血栓形成的临床特点研究[J].传染病信息, 2013, 26(3): 164-167.

WU Q, CHU J D, JIN B, et al. Clinical characteristics of portal vein thrombosis in patients with liver cirrhosis[J]. Infect Dis Info, 2013, 26(3): 164-167.

LI M X, ZHANG X F, LIU Z W, et al. Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis[J]. HBPD INT, 2013, 12(5): 512-519. DOI:10.1016/s1499-3872(13)60081-8.

FRANCOZ C, VALLA D, DURAND F. Portal vein thrombosis, cirrhosis, and liver transplantation[J]. J Hepatol, 2012, 57(1): 203-212. DOI: 10.1016/j.jhep.2011.12.034.

LUCA A, CARUSO S, MILAZZO M, et al. Natural course of extrahepatic nonmalignant partial portal vein thrombosis inpatients with cirrhosis[J]. Radiology, 2012, 265(1): 124-132.DOI: 10.1148/radiol.12112236.

LISMAN T. Low molecular weight heparin in management and prevention of portal vein thrombosis[J]. Thromb Res, 2014, 134(4): 761-762. DOI: 10.1016/j.thromres.2014.08.003.

RODRIGUEZ-CASTRO K I, SIMIONI P, BURRA P, et al. Anticoagulation for the treatment of thrombotic complications in patients with cirrhosis[J]. Liver Int, 2012, 32(10): 1465-1476. DOI: 10.1111/j.1478-3231.2012.02839.x.

ENGLESBE M J, KUBUS J, MUHAMMAD W, et al. Portal vein thrombosis and survival in patients with cirrhosis[J]. Liver Transpl, 2010, 16(1): 83-90. DOI:10.1002/lt.21941.

LV Y, QI X, HE C, et al. Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of varicealrebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial[J]. Gut, 2017: gutjnl-2017-314634. DOI: 10.1136/gutjnl-2017-314634.

LUCA A, MIRAGLIA R, CARUSO S, et al. Short- andlong-term effects of the transjugular intrahepatic portosystemicshunt on portal vein thrombosis in patients with cirrhosis[J]. Gut, 2011, 60(6): 846-852. DOI: 10.1136/gut.2010.228023.

HAN G, QI X, HE C, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis[J]. J Hepatol, 2011, 54(1): 78-88. DOI: 10.1016/j.jhep.2010.06.029.

WANG Z, JIANG M S, ZHANG H L, et al. Is Post-TIPS Anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? A randomized controlled trial[J]. Radiology, 2016, 279(3): 943-951. DOI: 10.1148/radiol.2015150369.

GARCIA-TSAO G, BOSCH J. Management of varices and variceal hemorrhage in cirrhosis[J]. N Engl J Med, 2010, 362(9): 823-832. DOI: 10.1056/NEJMra0901512.

JALAN R, HAYES P C. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. British society of gastroenterology[J]. Gut, 2000, 46(Suppl 3-4): Ⅲ1-Ⅲ15. DOI: 10.1136/gutjnl-2015-309262.

HOLSTER I L, TJWA E T, MOELKER A, et al. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy+β-blocker for prevention of variceal rebleeding[J]. Hepatology, 2016, 63(2): 581-589. DOI:10.1002/hep.28318.

SAUER P, HANSMANN J, RICHTER G M, et al. Endoscopic variceal ligation plus propranolol vstransjugular intrahepatic portosystemic stent shunt: a long-term randomized trial[J]. Endoscopy, 2002, 34(9): 690-697. DOI:10.1055/s-2002-33565.

POMIER-LAYRARGUES G, VILLENEUVE J P, DESCH NES M, et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding inpatients with cirrhosis: a randomised trial[J]. Gut, 2001, 48(3): 390-396. DOI: 10.1136/gut.48.3.390.

LUO X, WANG Z, TSAUO J, et al. Advanced cirrhosis combined with portal vein thrombosis: a randomized trial of TIPS versus endoscopic band ligation plus propranolol for the prevention of recurrent esophageal variceal bleeding[J]. Radiology, 2015, 276(1): 286-293. DOI: 10.1148/radiol.15141252.

R SSLE M. TIPS: 25 years later[J]. J Hepatol, 2013, 59(5): 1081-1093. DOI: 10.1016/j.jhep.2013.06.014.

WANG Q, LV Y, BAI M, et al. Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding[J]. J Hepatol, 2017, 67(3): 508-516. DOI: 10.1016/j.jhep.2017.05.006.

HAN G, QI X, HE C, et al. Reply to:tips for portal vein thrombosis (pvt) in cirrhosis: not only unblocking a pipe[J]. Journal of Hepatology, 2011, 55(4): 947-948. DOI: 10.1016/j.jhep.2011.03.003.

SALEM R, VOUCHE M, BAKER T, et al. Pretransplant portal vein recanalization-transjugular intrahepatic portosystemic shunt in patients with complete obliterative portal vein thrombosis[J]. Transplantation, 2015, 99(11): 2347-2355. DOI: 10.1097/TP.0000000000000729.

THORNBURG B, DESAI K, HICKEY R, et al. Portal vein recanalization and transjugular intrahepatic portosystemic shunt creation for chronic portal vein thrombosis: technical considerations[J]. Tech Vasc Interv Radiol, 2016, 19(1): 52-60. DOI: 10.1053/j.tvir.2016.01.006.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

肝硬化门脉高压症患者胃菌群特征分析

肝硬化伴自发性细菌性腹膜炎的诊断模型研究及验证

国际标准化比值和终末期肝病模型评分对并发肝性脑病的肝硬化患者短期预后的预测价值

85例结外鼻型NK/T细胞淋巴瘤治疗及预后的回顾性观察

某医院近5年肝硬化患者冰冻血浆输注回顾性调查分析