肝硬化并发症患者经TIPS术治疗的临床预后分析

摘要/Abstract

摘要： 目的分析合并不同并发症的肝硬化患者经TIPS术治疗后的临床预后,探索TIPS术治疗肝硬化患者的最佳适应证。方法选择2014年1月—2016年1月遂宁市中心医院收治肝硬化伴门静脉高压患者80例,因食管静脉曲张出血或难治性腹水而行TIPS治疗,并分为静脉出血组(VB组)以及难治性腹水组(RA组)。收集上述病例的一般临床特征,如年龄、性别、Child评分、MELD评分等,使用Kaplan-Meier方法计算生存率,log-rank检验比较不同组别的生存情况。结果两组间年龄[VB组:(61.4±10.3)岁,RA组:(63.5±10.5)岁]、性别(VB组男/女:32/20,RA组男/女:15/13)、Child分级病例数(VB组A级/B级/C级:24/26/2,RA组A级/B级/C级:7/18/3)及MELD评分(VB组:11.35±4.4,RA组:13.2±5.3)无差异(P>0.05),但两组间平均生存时间存在明显差异(P=0.008),RA组平均生存时间为28月,而VB组超过60月;支架术后狭窄患者的平均生存时间为50月,支架术后无狭窄患者超过60月,两组间平均生存时间存在明显差异(P=0.025);MELD评分≤10患者的平均生存时间为51.3月,MELD评分>10患者为36.1月,两组间平均生存时间存在明显差异(P=0.001);总生存曲线显示,本研究患者TIPS术后生存率呈逐渐下降的趋势,60月时间节点的生存率为45.3%。结论与肝硬化合并难治性腹水患者相比,肝硬化合并食管静脉曲张出血患者经TIPS术治疗后,具有更大的获益,且支架术后狭窄及MELD评分>10与肝硬化患者TIPS术后平均生存时间密切相关。

关键词: 经颈静脉肝内门体分流术, 难治性腹水, 食管静脉曲张出血, 预后, 适应证

Abstract: Objective To investigate the clinical outcome of liver cirrhosis patients with different complications treated by transjugular intrahepatic portosystemic shunt (TIPS) and investigate the best indications of TIPS for patients with cirrhosis. Methods A total of 80 patients with liver cirrhosis and portal hypertension treated by TIPS were included, they were divided into refractory ascites (RA) group and variceal bleeding (VB) group according to the complication. Clinical data including age, sex, Child score and the model for end-stage liver disease score (MELD score) were collected and analyzed. The Kaplan Meier method was used to calculate survival rate and log rank test was used to compare the survival condition. Results There was no significant difference of age (VB group: 61.4±10.3 years,RA group: 63.5±10.5 years), sex (male/female in VB group: 32/20, male/female in RA group: 15/13), Child score (level A/ level B/ level C in VB group: 24/26/2, level A/ level B/ level C in RA group: 7/18/3) or MELD score (VB group: 11.35±4.4,RA group: 13.2±5.3) between the 2 groups. The median survival times of RA and VB group were 28 months and 60 months respectively, and the difference was significant (P=0.008). After TIPS implantation, the average survival time of patients without stent occlusion (>60 months) was significantly higher than patients with stent occlusion (50 months), (P=0.025). The average survival time of patients with MELD score≤10 (51.3 months) was significantly higher than patients with MELD score>10 (36.1 months), (P=0.001). Overall survival curve showed there was a gradual decline of postoperative survival rates in patients with liver cirrhosis after the TIPS and survival rate was 45.3% at 60-month follow-up.Conclusion Compared to patients with liver cirrhosis and RA, patients with liver cirrhosis and VB benefit more from TIPS. In addition, stent occlusion and MELD score >10 are influencing factors of the survival time in patients with liver cirrhosis treated by TIPS.

Key words: Transjugular intrahepatic portosystemic shunt, Refractory ascites, Variceal bleeding, Outcome, Indications

姚勇, 奉镭, 刘天宇, 刘杰, 潘金. 肝硬化并发症患者经TIPS术治疗的临床预后分析[J]. 肝脏, 2023, 28(1): 61-64.

YAO Yong, FENG Lei, LIU Tian-yu, LIU Jie, PAN Jin. Clinical outcome of liver cirrhosis patients with different complications treated by TIPS[J]. Chinese Hepatolgy, 2023, 28(1): 61-64.

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