肝硬化患者自发性门体分流行TIPS治疗的预后分析OA
Prognostic analysis of transjugular intrahepatic portosystemic shunt treatment for spontaneous portosystemic shunts in patients with cirrhosis
目的:评估合并非食管胃底静脉曲张自发性门体分流(spontaneous portosystemic shunt,SPSS)的患者接受经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)联合栓塞治疗的预后.方法:回顾性分析2018年1月—2024年6月在南京医科大学第一附属医院接受TIPS治疗的603例患者,经纳入与排除标准筛选后分为SPSS组(SPSS组,n=141)和合并非食管胃底静脉曲张SPSS组(Non-EGV-SPSS组,n=58).收集并比较两组患者基线资料、手术前后门静脉压力、手术情况及术后上消化道再出血、支架失功、肝性脑病发生情况和生存预后等,Logistic回归分析患者不良预后的相关因素.结果:随访期间,两组共64例(32.2%)患者出现显性肝性脑病;42例(21.2%)患者发生再出血,其中7例接受内镜治疗、19例接受介入治疗、16例接受内科治疗;62例(31.2%)患者死亡,其中10例死于消化道再出血.两组患者的再出血风险均与门体压力梯度降低显著相关(P=0.021).Non-EGV-SPSS组的再出血风险高于SPSS组(36.2%vs.14.9%,P=0.001),而在死亡风险(36.2%vs.29.1%,P=0.400)或肝性脑病发生率(37.9%vs.29.8%,P=0.317)方面无显著差异.年龄(HR=1.049,95%CI:1.020～1.079,P=0.001)和血清肌酐(HR=1.012,95%CI:1.002～1.023,P=0.017)是术后肝性脑病发生的独立危险因素;术前合并Non-EGV-SPSS是术后再出血的独立危险因素;年龄(HR=1.025,95%CI:1.002～1.047,P=0.030)和血清总胆红素水平(HR=1.002,95%CI:1.000～1.005,P=0.012)是术后死亡发生的独立危险因素.结论:对于接受TIPS治疗的肝硬化患者,术前合并非食管胃底静脉曲张SPSS与更高的再出血风险相关,且这一风险与门静脉压力变化有关.然而,合并非食管胃底静脉曲张SPSS对TIPS术后死亡率或肝性脑病发生率无显著影响.
Objective:To evaluate the prognosis of patients with combined non-esophagogastric variceal spontaneous portosystemic shunt(SPSS)undergoing transjugular intrahepatic portosystemic shunt(TIPS)combined with embolization.Methods:We performed a retrospective analysis of 603 cirrhotic patients who underwent TIPS at the First Affiliated Hospital of Nanjing Medical University between January 2018 and June 2024.After applying inclusion and exclusion criteria,patients were divided into two groups:the SPSS group(n=141)and the non-esophagogastric variceal SPSS group(Non-EGV-SPSS group,n=58).Baseline data,preoperative and postoperative portal vein pressure,intraoperative parameters,and postoperative outcomes(such as upper gastrointestinal rebleeding,stent dysfunction,hepatic encephalopathy,and survival prognosis)were collected and analyzed,Logistic regression analysis was employed to determine independent predictors of adverse prognosis.Results:During follow-up,64 patients(32.2%)developed overt hepatic encephalopathy.Rebleeding occurred in 42 cases(21.2%)of patients,among which 7 cases received endoscopic therapy,19 cases received interventional treatment,and 16 cases received medical treatment.Sixty-two cases(31.2%)died,among which 10 died of gastrointestinal rebleeding.The rebleeding risk of both groups was significantly associated with the reduction of portal pressure gradient(P=0.021).The Non-EGV-SPSS group exhibited a significantly higher rebleeding risk compared with the SPSS group(36.2%vs.14.9%,P=0.001).In contrast,no statistically significant differences were noted in mortality(36.2%vs.29.1%,P=0.400)or hepatic encephalopathy incidence(37.9%vs.29.8%,P=0.317)between the two groups.Age(HR=1.049,95%CI:1.020～1.079,P=0.001)and serum creatinine(HR=1.012,95%CI:1.002～1.023,P=0.017)were independent risk factors for post-operative hepatic encephalopathy.Pre-operative Non-EGV-SPSS was an independent risk factor for post-operative rebleeding;Age(HR=1.025,95%CI:1.002～1.047,P=0.030)and serum total bilirubin level(HR=1.002,95%CI:1.000～1.005,P=0.012)were independent risk factors for post-operative mortality.Conclusion:In cirrhotic patients undergoing TIPS,preoperative non-esophagogastric variceal SPSS is associated with an increased postoperative rebleeding risk,which correlates with changes in portal vein pressure.However,non-esophagogastric variceal SPSS does not significantly impact postoperative mortality or the incidence of hepatic encephalopathy.
苏昊;吴必飞;杨魏;刘圣;施海彬;周卫忠
南京医科大学第一附属医院介入放射科,江苏 南京 210029南京医科大学第一附属医院介入放射科,江苏 南京 210029南京医科大学第一附属医院介入放射科,江苏 南京 210029南京医科大学第一附属医院介入放射科,江苏 南京 210029南京医科大学第一附属医院介入放射科,江苏 南京 210029南京医科大学第一附属医院介入放射科,江苏 南京 210029
医药卫生
肝硬化肝性脑病非食管胃底静脉曲张自发性门体分流经颈静脉肝内门体分流术栓塞
cirrhosishepatic encephalopathynon-esophagogastric varicesspontaneous portosystemic shunttransjugular intrahe-patic portosystemic shuntembolization
《南京医科大学学报（自然科学版）》 2026 (5)
691-699,9
北京陈菊梅公益基金会(Z2026010285)
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