经颈静脉肝内门体分流术对酒精性肝硬化导致门静脉高压的治疗效果与安全性分析

• Main Author: TANG Shanhong
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2014-02-01
• Series: Linchuang Gandanbing Zazhi
• Subjects: liver cirrhosis; alcoholic; portasystemic shunt; transjugular intrahepatic; hypertension; portal
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=5645&ClassID=1230125834
• ISSN: 1001-5256; 1001-5256

ObjectiveTo evaluate the clinical effect and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension due to alcoholic cirrhosis. MethodsA retrospective analysis was performed on the clinical data of 30 patients with portal hypertension due to alcoholic cirrhosis who received TIPS in our hospital; the clinical indices before and after TIPS were recorded to evaluate portal venous pressure, ascites, hypersplenism, and liver function. Postoperative follow-up was performed for 2 years to detect the complications including recurrent variceal bleeding, in-stent restenosis, ascites, and hepatic encephalopathy, and the relationship between the incidence of hepatic encephalopathy and clinical indices was analyzed. The change in portal venous pressure after puncture was evaluated by paired t test; the Kaplan-Meier method was used to analyze the correlation between clinical indices and the incidence of hepatic encephalopathy after TIPS. ResultsThe success rate of TIPS was 100% (30/30). The portal venous pressure was significantly decreased from 37.27±2.52 cm H2O before operation to 24.6±2.58 cm H2O after operation (P＜0.05). Within 2 years after TIPS, the recurrence rate of variceal bleeding was 3.3% (1/30); the response rate in ascites treatment was 88.9% (16/18); the incidence of in-stent restenosis was 6.7% (2/30); the incidence of hepatic encephalopathy was 40% (12/30). The Kaplan-Meier analysis indicated that the Child-Pugh classification before TIPS was significantly correlated with the postoperative incidence of hepatic encephalopathy (P=0.04). ConclusionTIPS is an effective and safe minimally invasive therapy for portal hypertension-related complications in patients with alcoholic cirrhosis. Preoperative Child-Pugh classification is an important influential factor for the postoperative incidence of hepatic encephalopathy.