中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2012年
9期
830-835
,共6页
刘福全%岳振东%赵洪伟%王磊%李志伟%余灵祥%李捍卫%金波%范振华%赵孟菲%姚健楠%左力
劉福全%嶽振東%趙洪偉%王磊%李誌偉%餘靈祥%李捍衛%金波%範振華%趙孟菲%姚健楠%左力
류복전%악진동%조홍위%왕뢰%리지위%여령상%리한위%금파%범진화%조맹비%요건남%좌력
肝硬化%高血压,门静脉%门体分流术,经颈静脉肝内%放射摄影术,介入性
肝硬化%高血壓,門靜脈%門體分流術,經頸靜脈肝內%放射攝影術,介入性
간경화%고혈압,문정맥%문체분류술,경경정맥간내%방사섭영술,개입성
Liver cirrhosis%Hypertension,portal%Portosystemic shunt, transjugular intrahepatic%Radiography,interventional
目的 探讨经颈静脉肝内门-体分流术(TIPS)再次介入治疗肝硬化门静脉高压的安全性、有效性及临床影响因素.方法 回顾分析771例应用TIPS治疗肝硬化门静脉高压患者的临床资料,其中再次介入463例,共计625例获得随访,根据介入治疗次数将患者分为治疗1次组(组1)219例,治疗2次组(组2)246例和治疗3次及以上组(组3)160例.对比分析3组患者的临床症状、生存率、再狭窄率,重点探讨影响再次介入治疗的效果和因素.结果 所有患者初次手术成功率98.2％(757/771),病死率0.7％( 5/757)、严重合并症发生率2.5％( 19/757)；再次手术成功率98.7％(457/463),无严重合并症及死亡发生.3组结果显示:术后1年再狭窄率组3患者明显低于组1(x2 =7.908,P＜0.05),组2分别与组1(x2=3.777,P ＞0.05)和组3(x2=1.l00,P ＞0.05)比较,差异无统计学意义；2 ～5年再狭窄率组2及组3均明显低于组1(x2值分别为27.046、25.724、37.002、19.046,P值均＜0.05).1年生存率组3和组2均明显高于组1(x2值分别为9.114、4.929,P值均＜0.05),但组2与组3相比差异无统计学意义(x2=2.678,P＞0.05)；2～5年生存率组2及组3也明显高于组1(x2值分别为41.314、26.920、13.692、6.713,P值均＜0.05).再次介入治疗的患者19.4％(79/406)有症状复发与分流道狭窄或闭塞同时存在；单纯症状复发伴有预示门静脉压力增高临床症状,及单纯分流道狭窄或闭塞伴有预示门静脉压力增高症状的患者分别为11.6％(47/406)与62.8％(255/406).结论 分流道狭窄或闭塞、症状复发及预示门静脉压力增高等是再次介入治疗的主要原因.TIPS再次介入治疗安全有效,可以提高患者的长期生存率及支架通畅率.
目的 探討經頸靜脈肝內門-體分流術(TIPS)再次介入治療肝硬化門靜脈高壓的安全性、有效性及臨床影響因素.方法 迴顧分析771例應用TIPS治療肝硬化門靜脈高壓患者的臨床資料,其中再次介入463例,共計625例穫得隨訪,根據介入治療次數將患者分為治療1次組(組1)219例,治療2次組(組2)246例和治療3次及以上組(組3)160例.對比分析3組患者的臨床癥狀、生存率、再狹窄率,重點探討影響再次介入治療的效果和因素.結果 所有患者初次手術成功率98.2％(757/771),病死率0.7％( 5/757)、嚴重閤併癥髮生率2.5％( 19/757)；再次手術成功率98.7％(457/463),無嚴重閤併癥及死亡髮生.3組結果顯示:術後1年再狹窄率組3患者明顯低于組1(x2 =7.908,P＜0.05),組2分彆與組1(x2=3.777,P ＞0.05)和組3(x2=1.l00,P ＞0.05)比較,差異無統計學意義；2 ～5年再狹窄率組2及組3均明顯低于組1(x2值分彆為27.046、25.724、37.002、19.046,P值均＜0.05).1年生存率組3和組2均明顯高于組1(x2值分彆為9.114、4.929,P值均＜0.05),但組2與組3相比差異無統計學意義(x2=2.678,P＞0.05)；2～5年生存率組2及組3也明顯高于組1(x2值分彆為41.314、26.920、13.692、6.713,P值均＜0.05).再次介入治療的患者19.4％(79/406)有癥狀複髮與分流道狹窄或閉塞同時存在；單純癥狀複髮伴有預示門靜脈壓力增高臨床癥狀,及單純分流道狹窄或閉塞伴有預示門靜脈壓力增高癥狀的患者分彆為11.6％(47/406)與62.8％(255/406).結論 分流道狹窄或閉塞、癥狀複髮及預示門靜脈壓力增高等是再次介入治療的主要原因.TIPS再次介入治療安全有效,可以提高患者的長期生存率及支架通暢率.
목적 탐토경경정맥간내문-체분류술(TIPS)재차개입치료간경화문정맥고압적안전성、유효성급림상영향인소.방법 회고분석771례응용TIPS치료간경화문정맥고압환자적림상자료,기중재차개입463례,공계625례획득수방,근거개입치료차수장환자분위치료1차조(조1)219례,치료2차조(조2)246례화치료3차급이상조(조3)160례.대비분석3조환자적림상증상、생존솔、재협착솔,중점탐토영향재차개입치료적효과화인소.결과 소유환자초차수술성공솔98.2％(757/771),병사솔0.7％( 5/757)、엄중합병증발생솔2.5％( 19/757)；재차수술성공솔98.7％(457/463),무엄중합병증급사망발생.3조결과현시:술후1년재협착솔조3환자명현저우조1(x2 =7.908,P＜0.05),조2분별여조1(x2=3.777,P ＞0.05)화조3(x2=1.l00,P ＞0.05)비교,차이무통계학의의；2 ～5년재협착솔조2급조3균명현저우조1(x2치분별위27.046、25.724、37.002、19.046,P치균＜0.05).1년생존솔조3화조2균명현고우조1(x2치분별위9.114、4.929,P치균＜0.05),단조2여조3상비차이무통계학의의(x2=2.678,P＞0.05)；2～5년생존솔조2급조3야명현고우조1(x2치분별위41.314、26.920、13.692、6.713,P치균＜0.05).재차개입치료적환자19.4％(79/406)유증상복발여분류도협착혹폐새동시존재；단순증상복발반유예시문정맥압력증고림상증상,급단순분류도협착혹폐새반유예시문정맥압력증고증상적환자분별위11.6％(47/406)여62.8％(255/406).결론 분류도협착혹폐새、증상복발급예시문정맥압력증고등시재차개입치료적주요원인.TIPS재차개입치료안전유효,가이제고환자적장기생존솔급지가통창솔.
Objective To evaluate the safety,effectiveness and clinical factors of re-intervention of transjugular intrahepatic porto-systemic shunt (TIPS).Methods A retrospective study of safety and longterm outcomes of TIPS was made in 771 patients from August 1994 to August 2010.The 625 patients had follow-up data.The patients who received TIPS once,twice,and more than twice were divided into group 1,group 2 and group 3,respectively.Clinical symptoms,survival rate and restenosis rate of each group were analyzed.Clinical influencing factors of re-intervention effect were discussed.Results The success rate of first intervention was 98.2％ (757/771),the death rate was 0.7％ (5/757) and severe complication rate was 2.5％ (19/757).The success rate of re-intervention was 98.7％ (457/463),no death and severe complications occurred.The restenosis rate in group 3 decreased significantly than group 1 ( x2 =7.908,P ＜0.05 ) in the first year of TIPS.The restenosis rates in group 2 and group 3 were lower than group 1 from 2 to 5 years of TIPS ( x2 values were 27.046,25.724,37.002 and 19.046,respectively,P ＜ 0.05 ). The survival rate in group 3 was higher than group 1 (x2 =9.114,P＜0.05)and group 2 was higher than group 1 ( x2 =4.929,P ＜ 0.05 ) in the first year of TIPS,while there was no statistical difference between group 2 and group 3 ( x2 =2.678,P ＞ 0.05).The patients in group 2 and group 3 also had higher survival rates than group 1 from 2 to 5 years of TIPS (x2 value were 41.314,26.920,13.692 and 6.713,respectively,P ＜ 0.05 ).19.4％ (79/406)of patients who received re-intervention had symptom recurrence and shunt stenosis or occlusion. 11.6％ (47/406) of patients had symptom recurrence with portal hypertension signs,62.8％ (255/406) had shunt stenosis or occlusion with portal hypertension signs.Conclusions Restenosis or occlusion of TIPS,symptom recurrence and portal hypertension signs were important factors for re-intervention.Re-intervention of TIPS was safe and effective,and could improve the survival rate of patients with TIPS.
