经颈静脉肝内门体分流术治疗乙型肝炎肝硬化合并或不合并门静脉血栓形成的比较

肝脏 ›› 2023, Vol. 28 ›› Issue (4): 448-451.

经颈静脉肝内门体分流术治疗乙型肝炎肝硬化合并或不合并门静脉血栓形成的比较

易艳容, 申月明, 王赛, 彭雄群, 彭誉

410004 湖南南华大学附属长沙中心医院消化内科(易艳容,申月明, 王赛,彭雄群); 中南大学湘雅医院消化内科(彭誉)

收稿日期:2022-11-25 出版日期:2023-04-30 发布日期:2023-08-29
通讯作者: 彭雄群, Email:pxq01043@163.com
基金资助:
湖南省卫生健康委科研计划课题(D202303037199);长沙市自然科学基金资助项目(kq2014021);南华大学附属长沙中心医院科研项目(YNKY202139)

A comparison of transjugular intrahepatic portal-systemic shunt in the treatment of hepatitis B cirrhosis with or without portal vein thrombosis

YI Yan-rong¹, SHEN Yue-ming¹, WANG Sai¹, PENG Xiong-qun¹, PENG Yu²

1. Department of Gastroenterology, Changsha Central Hospital Affiliated to South China University, Hunan 410004, China;
2. Department of Gastroenterology, Xiangya Hospital, Central South University,Changsha 410000, China

Received:2022-11-25 Online:2023-04-30 Published:2023-08-29
Contact: PENG Xiong-qun, Email:pxq01043@163.com

摘要/Abstract

摘要： 目的探究经颈静脉肝内门体分流术(TIPS)治疗合并或不合并门静脉血栓形成(PVT)的肝硬化患者的疗效。方法选取2019年1月—2022年12月南华大学附属长沙中心医院采用TIPS成功治疗的203例肝硬化患者,其中有PVT肝硬化患者72例,非PVT肝硬化患者131例,收集数据以评估TIPS创建后的死亡率、分流功能障碍和并发症发生率。结果 PVT肝硬化患者72例,非PVT肝硬化患者131例。PVT组PLT、Hb及总胆红素分别为(107.2±32.4)×10⁹/L、(76.4±21.7)g/L及(24.6±6.5)mg/dL,分别与PVT组[(65.4±17.7)×10⁹/L、(84.2±26.2)g/L及(33.2±8.4)mg/dL]相比,差异具有统计学意义(P<0.05)。随访患者,21例(10.3%)患者死亡。死因包括肝功能衰竭8例(3.9%)、多器官衰竭6例(2.9%)、胃肠道出血2例(0.9%)、肝肾综合征1例(0.5%)、败血症1例(0.5%)、脑出血1例(0.5%),其他疾病2例(0.9%)。PVT组、非PVT组在90 d的累积死亡发生率分别为2.6%、7.5%,差异无统计学意义(P>0.05);PVT组、非PVT组在整个随访期间的累积死亡发生率分别为10.3%、16.4%,差异无统计学意义(P>0.05)。静脉曲张出血(胃+食管)是TIPS的主要适应证,PVT组、非PVT组静脉曲张出血例数差异有统计学意义(P<0.05)。TIPS的主要并发症复发性静脉曲张出血和复发性腹水在两组之间相似,而两组明显的肝性脑病发生率存在显著差异(P<0.05)。随访期间两组间分流功能障碍的累积发生率差异有统计学意义(P<0.05)。结论 TIPS在治疗伴有PVT的肝硬化中是可行的。与PVT组相比,非PVT组的静脉曲张出血率和复发性腹水发生率没有显著差异,明显的肝性脑病和分流功能障碍发生率具有显著差异。TIPS为PVT肝硬化患者的一种潜在可行的治疗选择。

关键词: 经颈静脉肝内门体分流术, 门静脉血栓, 肝硬化

Abstract: Objective To explore the efficacy of transjugular intrahepatic portal-systemic shunt (TIPS) in patients with hepatitis B cirrhosis with or without portal vein thrombosis (PVT). Methods A total of 203 patients with hepatitis B cirrhosis who were successfully treated with TIPS between January 2019 and December 2022 were selected, including 72 patients with PVT and 131 patients without PVT. Data were collected to assess the mortality, shunt dysfunction, and complication rates between these two groups of patients after TIPS operation. Results In PVT group, the platelet count (PLT), hemoglobin (Hb) and total bilirubin levels were (107.2±32.4)×10⁹/L, (76.4±21.7)g/L and (24.6±6.5)mg/dL, respectively, which were statistically different from those of [(65.4±17.7)×10⁹/L, (84.2±26.2)g/L and (33.2±8.4)mg/dL] in the PVT group (P<0.05). A total of twenty-one patients (10.3%) died during follow-up. The causes of death included liver failure (8 cases, 3.9%), multiple organ failure (6 cases, 2.9%), gastrointestinal bleeding (2 cases, 0.9%), hepatorenal syndrome (1 case, 0.5%), sepsis (1 case, 0.5%), cerebral hemorrhage (1 case, 0.5%) and other diseases (2 cases, 0.9%). The cumulative mortality rates of PVT group and non-PVT group at 90 days were 2.6% and 7.5%, and the difference was not statistically significant (P>0.05). The cumulative mortality rates of PVT group and non-PVT group during the whole follow-up period were 10.3% and 16.4%, respectively, without statistical significant difference (P>0.05). There was a statistical difference between PVT group and non-PVT group in varicose bleeding (esophagus and stomach), which was the main indication of TIPS (P<0.05). The main complications of TIPS, the recurrence of varicose bleeding and the recurrence of ascites were similar, but there were significant differences between the two groups in obvious hepatic encephalopathy (P<0.05). During the follow-up period, the cumulative incidence of shunt dysfunction between the two groups was significantly different (P<0.05). Conclusion TIPS is feasible in the treatment of cirrhosis with PVT. Compared with the PVT group, there were no significant differences in the incidence of variceal bleeding and recurrent ascites, but significant differences existed in the incidence of hepatic encephalopathy and shunt dysfunction in patients of the non-PVT group. TIPS represent a potentially viable treatment option for patients with PVT cirrhosis.

Key words: Transjugular intrahepatic portosystemic shunt, Portal vein thrombosis, Cirrhosis

易艳容, 申月明, 王赛, 彭雄群, 彭誉. 经颈静脉肝内门体分流术治疗乙型肝炎肝硬化合并或不合并门静脉血栓形成的比较[J]. 肝脏, 2023, 28(4): 448-451.

YI Yan-rong, SHEN Yue-ming, WANG Sai, PENG Xiong-qun, PENG Yu. A comparison of transjugular intrahepatic portal-systemic shunt in the treatment of hepatitis B cirrhosis with or without portal vein thrombosis[J]. Chinese Hepatolgy, 2023, 28(4): 448-451.

参考文献

[1] Rodriguez-Castro KI, Porte RJ, Nadal E, et al. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation, 2012, 94(11): 1145-1153.
[2] Bureau C, Thabut D, Oberti F, et al. Transjugular Intrahepatic Portosystemic Shunts With Covered Stents Increase Transplant-Free Survival of Patients With Cirrhosis and Recurrent Ascites. Gastroenterology, 2017, 152(1): 157-163.
[3] Njei B, McCarty TR, Laine L. Early transjugular intrahepatic portosystemic shunt in US patients hospitalized with acute esophageal variceal bleeding. J Gastroenterol Hepatol, 2017, 32(4): 852-858.
[4] Sobhonslidsuk A, Reddy KR. Portal vein thrombosis: a concise review. Am J Gastroenterol, 2002, 97(3): 535-541.
[5] Zocco MA, Di Stasio E, De Cristofaro R, et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol, 2009, 51(4): 682-689.
[6] Ghazaleh S, Beran A, Aburayyan K, et al. Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis: a systematic review and meta-analysis. Ann Gastroenterol, 2021, 34(1): 104-110.
[7] Qi X, De Stefano V, Li H, et al. Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Eur J Intern Med, 2015, 26(1): 23-29.
[8] Rossle M. TIPS: 25 years later. J Hepatol, 2013, 59(5): 1081-1093.
[9] Tan HK, James PD, Sniderman KW, et al. Long-term clinical outcome of patients with cirrhosis and refractory ascites treated with transjugular intrahepatic portosystemic shunt insertion. J Gastroenterol Hepatol, 2015, 30(2): 389-395.
[10] Luca A, Miraglia R, Caruso S, et al. Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis. Gut, 2011, 60(6): 846-852.
[11] Han G, Qi X, He C, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis. J Hepatol, 2011, 54(1): 78-88.
[12] Chalasani N, Clark WS, Martin LG, et al. Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting. Gastroenterology, 2000, 118(1): 138-144.
[13] Lv Y, He C, Wang Z, et al. Association of Nonmalignant Portal Vein Thrombosis and Outcomes after Transjugular Intrahepatic Portosystemic Shunt in Patients with Cirrhosis. Radiology, 2017, 285(3): 999-1010.
[14] Perarnau JM, Baju A, D'Alteroche L, et al. Feasibility and long-term evolution of TIPS in cirrhotic patients with portal thrombosis. Eur J Gastroenterol Hepatol, 2010, 22(9): 1093-1098.
[15] 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 Hepatol, 2017, 67(3): 508-516.
[16] Praktiknjo M, Abu-Omar J, Chang J, et al. Controlled underdilation using novel VIATORR(R) controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation. J HEP Rep, 2021, 3(3): 100264.
[17] Trebicka J, Bastgen D, Byrtus J, et al. Smaller-Diameter Covered Transjugular Intrahepatic Portosystemic Shunt Stents Are Associated With Increased Survival. Clin Gastroenterol Hepatol, 2019, 17(13): 2793-2799 e2791.