实用器官移植电子杂志 ›› 2020, Vol. 8 ›› Issue (4): 261-266.DOI: 10.3969/j.issn.2095-5332.2020.04.00

• 论著 • 上一篇    下一篇

经颈静脉肝内门体分流术后肝移植单中心经验总结

邓斐文,陈焕伟,甄作均   

  1. 佛山市第一人民医院肝脏胰腺外科,广东 佛山 528000
  • 出版日期:2020-07-20 发布日期:2021-06-22
  • 基金资助:
    2018 年佛山市医学类科技攻关项目(2018AB003501)

The single center experience of transjungular intohepatic portosystemic shuts for the bridge treatment to liver transplantation

Deng Feiwen,Chen Huanwei,Zhen Zuojun.   

  1. The Liver and pancreatic Surgery Department of The First People’s Hospital of Foshan. Foshan 528000,Guangdong,China.
  • Online:2020-07-20 Published:2021-06-22

摘要:

目的 探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystem shunts,TIPS)在肝 硬化失代偿期食管胃底静脉曲张破裂出血的治疗价值以及作为肝移植的桥接作用。方法 回顾性分析佛山 市第一人民医院 2015 年 1 月— 2019 年 12 月因肝硬化失代偿期并食管胃底静脉曲张破裂出血接受 TIPS 治疗 的21例患者的临床资料。结果 21例接受TIPS治疗的患者中男性19例,女性2例,中位年龄52(41~67)岁, 单纯 TIPS 组 15 例,TIPS + 肝移植(liver transplantation,LT)组 6 例,TIPS 支架全部采用覆膜支架,其中 6 例 TIPS 后接受肝移植手术治疗,TIPS 门静脉压力降低 7 ~ 24 cmH2O(1 cmH2O = 0.098 kPa)。TIPS 术后 中位随访时间单纯 TIPS 组为 37.5(4 ~ 53)个月,TIPS + LT 组为 47(27 ~ 54)个月,单纯 TIPS 组 4 例 肝细胞癌患者中 2 例术后分别发生肝细胞癌复发和上消化道再出血死亡,2 例术后肝细胞癌进展,1 例术后 新发肝细胞癌,TIPS + LT 组术后生存良好。结论 TIPS 在肝硬化失代偿期食管胃底静脉曲张破裂出血的患 者止血治疗中具有明显的有效性,对等待肝移植的患者起到很好的桥接作用。

关键词: 经静脉肝内门体分流术 , 急性食管胃底静脉曲张破裂出血 , 肝移植 , 治疗价值

Abstract:

Objective To explore the treatment value of transjugular introhepatic portosystemic shunts (TIPS)as the bridge to liver transplantation for the patients with acute variceal bleeding and decompensate liver cirrhosis. Methods The clinical data of the 21 patients with acute variceal bleeding who received TIPS at The First People’s Hospital of Foshan between January 2015 and December 2019 were analyzed retrospectively. Results Among the 21 patients,19 cases were male,2 cases were female. The median age was 52 (41 ~ 67)years. There were 15 cases in the TIPS group,6 cases in the TIPS plus liver transplantation group. Cover stent was used in all patients. TIPS treatment decreased the portal vein pressure significantly(7 cmH2O to 24 cmH2O) (1 cmH2O = 0.098 kPa). The median follow up time was 37.5 months for the TIPS group,and 27 months for the TIPS plus LT group respectively. There were 4 cases with hepatocellular carcinoma in the pure TIPS group ,one died of tumor recurrence and acute variceal bleeding recurrence in the TIPS group. Two cases had tumor recurrence. One case had new occurrence of hepatocellular carcinoma after TIPS treatment in the TIPS group. The patients lived wellin the TIPS plus liver transplantation group. Conclusion TIPS was with significant treatment value for the patients with acute variceal bleeding of decompensate liver cirrhosis,and TIPS also deserved as a bridge treatment for liver transplantation.

Key words: Transjugular introhepatic portosystemic shunts , Acute variceal bleeding , Liver transplantation, Treatment value