伴自发性门静脉分流孤立性静脉曲张破裂出血患者临床特点

肝脏 ›› 2024, Vol. 29 ›› Issue (2): 157-161.

伴自发性门静脉分流孤立性静脉曲张破裂出血患者临床特点

翁成钊, 王超, 张峻, 林思慧, 林冲, 陈世耀, 蒋炜

361000 福建复旦大学附属中山医院厦门医院消化科(翁成钊,王超,张峻,林思慧),放射科(林冲);200032 上海复旦大学附属中山医院消化科(陈世耀,蒋炜)

收稿日期:2023-09-08 出版日期:2024-02-29 发布日期:2024-03-18
通讯作者: 蒋炜,Email: jiang.wei@zs-hospital.sh.cn
基金资助:
福建省自然科学基金重点项目(2021D033),福建省医学创新课题(2022CXB020),厦门市医疗卫生指导性项目(3502Z20209046)

The clinical characteristics of patients with spontaneous portalsystemic shunt and isolated gastric variceal bleeding

WENG Cheng-zhao¹, WANG Chao¹, ZHANG Jun¹, LIN Si-hui¹, LIN Chong², CHEN Shi-yao³, JIANG Wei³

1. Department of Gastroenterology and Hepatology, Zhongshan Hospital(Xiamen Branch) Affiliated to Fudan University, Fujian 361000, China;
2. Department of Radiology, Zhongshan Hospital(Xiamen Branch) Affiliated to Fudan University, Fudan University, Fujian 361000, China;
3. Department of Gastroenterology, Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032, China

Received:2023-09-08 Online:2024-02-29 Published:2024-03-18
Contact: JIANG Wei, Email: jiang.wei@zs-hospital.sh.cn

摘要/Abstract

摘要： 目的了解伴自发性门静脉分流(SPSS)的孤立性静脉曲张(IGV-1)破裂出血患者的临床特点。方法回顾性分析伴SPSS的IGV-1破裂出血患者,记录不同的类型的SPSS患者门静脉直径、门静脉压力梯度(HVPG)、门静脉有无血栓、Child-Pugh评分、Meld评分、治疗方式,随访3年,记录术后再出血次数及生存情况。结果纳入IGV-1破裂出血患者37例,15例存在脾肾分流道,14例存在胃肾分流道,8例同时存在脾肾分流和胃肾分流。18例进行TIPS治疗,随访中出现再出血4例,肝性脑病4例;胃冠状静脉栓塞术联合部分脾栓塞术治疗6例,随访中再出血4例,死亡1例。内镜治疗患者9例,随访中再出血3例,肝性脑病1例,死亡1例。单因素Cox回归发现门静脉血栓(PVT)和HVPG是影响患者再出血的危险因素。结论伴SPSS的IGV-1患者再出血、腹水和PVT发生率较高,同时PVT和HVPG是再出血的危险因素,分流形式对IGV-1治疗方案的选择有重要价值。

关键词: 自发性门静脉分流, 孤立性静脉曲张, 门静脉血栓, 门静脉高压

Abstract: Objective To analyze the clinical characteristics of patients with spontaneous portalsystemic shunt and isolated gastric variceal bleeding. Methods A retrospective study was performed on the patients with spontaneous portalsystemic shunt (SPSS) and bleeding caused by isolated gastric varices type 1 (IGV-1). The portal vein diameter, Hepatic Venous Pressure Gradient (HVPG), portal vein thrombosis (PVT), Child Pugh score, MELD score and treatment method of different types of SPSS patients were recorded. The patients were followed up for 3 years, and recorded the number of bleedings and their survival rate. Results A total of thirty- seven patients were included in this study, including 15 patients with splenorenal shunt, 14 patients with gastrorenal shunt, and 8 patients with both splenorenal shunt and gastrorenal shunt. During the follow-up period of time, within 18 patients who were treated with transjugular intrahepatic portosystomic stent shunt (TIPS), 4 cases (22.2%) each occured rebleeding and hepatic encephalopathy. Six cases were treated with gastric coronary vein embolization combined with partial splenic embolization. Within them, 4 cases of rebleeding and 1 case of death occurred during the follow-up. Nine cases accepted endoscopic treatment. Within them, 3 cases (33.3%) had rebleeding, 1 patient (11.1%) had hepatic encephalopathy, and 1 case (11.1%) died during the follow-up. Univariate Cox regression analysis showed that PVT and the level of HVPG were risk factors for rebleeding. Conclusion The incidences of rebleeding, ascites and PVT in patients with SPSS and IGV-1 are high. PVT and the level of HVPG are risk factors associated with rebleeding. The form of shunt has important value for the selection of IGV-1 treatment options.

Key words: Spontaneous portal systemic shunt, Isolated gastric varices type 1, Portal vein thrombosis, Portal hypertension

翁成钊, 王超, 张峻, 林思慧, 林冲, 陈世耀, 蒋炜. 伴自发性门静脉分流孤立性静脉曲张破裂出血患者临床特点[J]. 肝脏, 2024, 29(2): 157-161.

WENG Cheng-zhao, WANG Chao, ZHANG Jun, LIN Si-hui, LIN Chong, CHEN Shi-yao, JIANG Wei. The clinical characteristics of patients with spontaneous portalsystemic shunt and isolated gastric variceal bleeding[J]. Chinese Hepatolgy, 2024, 29(2): 157-161.

参考文献

[1] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》解读[J]. 临床肝胆病杂志,2023,39(3):12.
[2] Lee E W, Shahrouki P, Alanis L, et al. Management options for gastric variceal hemorrhage[J]. JAMA Surgery,2019,154(6):540-548.
[3] 谭玉勇, 龚箭, 楚毅,等. 肝硬化胃静脉曲张伴自发性门体分流的诊治现状[J]. 中华消化内镜杂志,2023,40(1):78-81.
[4] Bazarbashi AN, Ryou M. Gastric variceal bleeding[J]. Curr Opin Gastroenterol,2019, 35(6):524-534.
[5] Bhat Y M, Weilert F F, Fredrick R T, et al. EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video)[J]. Gastrointest Endosc,2016,83(6):1164-1172.
[6] Simón-Talero M, Roccarina D, Martínez J, et al. Baveno VI-SPSS group from the baveno cooperation. Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis[J]. Gastroenterology, 2018,154(6):1694-1705.e4.
[7] Lipinski M, Saborowski M, Heidrich B, et al. Clinical characteristics of patients with liver cirrhosis and spontaneous portosystemic shunts detected by ultrasound in a tertiary care and transplantation centre[J]. Scand J Gastroenterol,2018,53(9):1107-1113.
[8] Seleem WM, Hanafy AS. Management of different types of gastric varices with band ligation: a 3-year experience[J]. Eur J Gastroenterol Hepatol,2017,29(8):968-972.
[9] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会消化内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 中华内科杂志,2023,62(1):7-22.
[10] European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol,2018,69(2):406-460.
[11] Tripathi D, Stanley AJ, Hayes PC, et al. Clinical services and standards committee of the british society of gastroenterology. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients[J]. Gut, 2015,64(11):1680-704.
[12] Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology,2017,65(1):310-335.
[13] Cheng LF, Wang Z Q, Li C Z, et al. Low incidence of complications from endoscopic gastric variceal obturation with butyl cyanoacrylate[J]. Clin Gastroenterol Hepatol,2010,8(9):760-766.
[14] Guo Y W, Miao HB, Wen Z F, et al. Procedure-related complications in gastric variceal obturation with tissue glue[J]. World J Gastroenterol,2017,23(43):7746-7755.
[15] Ríos Castellanos E, Seron P, Gisbert JP, et al. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension[J]. Cochrane Database Syst Rev,2015,(5):CD010180.
[16] Zhang M, Li P, Mou H, et al. Clip-assisted endoscopic cyanoacrylate injection for gastric varices with a gastrorenal shunt: a multicenter study[J]. Endoscopy,2019,51(10):936-940.
[17] Thiruvengadam SS, Sedarat A. The role of endoscopic ultrasound (EUS) in the management of gastric varices[J]. Curr Gastroenterol Rep,2021,23(1):1.
[18] 杨涛, 阴继凯, 鲁建国. 腹腔镜技术在门静脉高压症外科手术中的前景[J]. 外科理论与实践,2021,26(3):217-220.
[19] Borentain P, Soussan J, Resseguier N, et al. The presence of spontaneous portosystemic shunts increases the risk of complications after transjugular intrahepatic portosystemic shunt (TIPS) placement[J]. Diagn Interv Imaging,2016,97(6):643-650.
[20] Riggio O, Efrati C, Catalano C, et al. High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: a case-control study[J]. Hepatology, 2005,42(5):1158-1165.
[21] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华外科杂志,2019,57(12):885-892.
[22] 杨勇, 周晓东, 王卫涛等. 脾切除联合贲门周围血管离断术后门静脉系统血栓形成机制及预防研究进展[J]. 中华肝胆外科杂志,2019,25(6): 477-480.
[23] 黄龙, 于庆生, 郭彬彬. 肝硬化门静脉高压患者脾切除对血液流变学的影响及血栓形成分析[J]. 中华肝胆外科杂志,2020,26(8):4.
[24] 王燕颖, 朱雅琪. 脾静脉血栓形成导致门静脉高压症的诊断[J]. 中华内科杂志,2005,44(12):949-951.