介入放射学杂志
介入放射學雜誌
개입방사학잡지
JOURNAL OF INTERVENTIONAL RADIOLOGY
2014年
8期
672-678
,共7页
赵洪伟%刘福全%岳振东%王磊%范振华%董成宾
趙洪偉%劉福全%嶽振東%王磊%範振華%董成賓
조홍위%류복전%악진동%왕뢰%범진화%동성빈
肝性脑病%经颈静脉肝内门体静脉分流术%门静脉血栓%覆膜支架
肝性腦病%經頸靜脈肝內門體靜脈分流術%門靜脈血栓%覆膜支架
간성뇌병%경경정맥간내문체정맥분류술%문정맥혈전%복막지가
hepatic encephalopathy%transjugular intrahepatic portasystemic shunt%portal vein thrombosis%covered stent
目的：通过建立慢性门静脉血栓解剖分型指导临床TIPS操作，探讨分析不同类型门静脉血栓术后肝性脑病（HE）的发生与TIPS术式选择的关系。方法2010年6月-2013年6月收治慢性门静脉血栓患者73例，行Fluency覆膜支架TIPS治疗。根据门静脉系统血栓不同部位，建立门静脉系统血栓解剖分型，评估TIPS手术前后门静脉压力变化、不同类型血栓患者接受TIPS治疗后15 d和3、6个月出现HE状况及病例数，并进行同一时间组间和不同时间变化对比。结果 TIPS治疗中Ⅰ型患者的分流前、后的门静脉压力分别为（42．7±9．6）和（35．0±6．7）cm H2O，差异有统计学意义（P<0．01）；Ⅱ型患者分别为（39．8±5．5）和（31．0±5．7）cm H2O，差异有统计学意义（t =17．2，P <0．01）；Ⅲ型患者 TIPS 分别为（43．2±5．8）和（32．4±5．0）cm H2O，差异有统计学意义（t =25．0，P <0．01）；Ⅳ型患者分别为（43．0±3．7）和（36．6±6．6）cm H2O，差异有统计学意义（t=4．26，P<0．01）。术后15 d时发生轻微HE（MHE）的前三者为Ⅳ、Ⅰ和Ⅲb型，发生Ⅰ期HE前三者为Ⅱa、Ⅲb和Ⅰ型，发生Ⅱ期HE的前三者为Ⅱb、Ⅲb和Ⅰ型；术后3个月时发生MHE的前三者为Ⅲa、Ⅱa和Ⅱc型，发生Ⅰ期HE的前三者为Ⅲa、Ⅱb和Ⅳ型，发生Ⅱ期HE的前三者为Ⅱa、Ⅱb和Ⅲb型；术后6个月时发生MHE的前三者为Ⅱa、Ⅱc和Ⅲb型，发生I期HE的前三者为Ⅱb、Ⅰ和Ⅲb型，发生Ⅱ期HE的前三者为Ⅱb、Ⅲb和Ⅰ型；且Ⅱb、Ⅲb和Ⅰ型TIPS术后HE持续时间较长。结论建立合理的慢性门静脉系统血栓解剖分型可以有效的指导临床TIPS的应用，术后HE在单纯门静脉主干和单纯肠系膜上静脉血栓中的发生概率较高。
目的：通過建立慢性門靜脈血栓解剖分型指導臨床TIPS操作，探討分析不同類型門靜脈血栓術後肝性腦病（HE）的髮生與TIPS術式選擇的關繫。方法2010年6月-2013年6月收治慢性門靜脈血栓患者73例，行Fluency覆膜支架TIPS治療。根據門靜脈繫統血栓不同部位，建立門靜脈繫統血栓解剖分型，評估TIPS手術前後門靜脈壓力變化、不同類型血栓患者接受TIPS治療後15 d和3、6箇月齣現HE狀況及病例數，併進行同一時間組間和不同時間變化對比。結果 TIPS治療中Ⅰ型患者的分流前、後的門靜脈壓力分彆為（42．7±9．6）和（35．0±6．7）cm H2O，差異有統計學意義（P<0．01）；Ⅱ型患者分彆為（39．8±5．5）和（31．0±5．7）cm H2O，差異有統計學意義（t =17．2，P <0．01）；Ⅲ型患者 TIPS 分彆為（43．2±5．8）和（32．4±5．0）cm H2O，差異有統計學意義（t =25．0，P <0．01）；Ⅳ型患者分彆為（43．0±3．7）和（36．6±6．6）cm H2O，差異有統計學意義（t=4．26，P<0．01）。術後15 d時髮生輕微HE（MHE）的前三者為Ⅳ、Ⅰ和Ⅲb型，髮生Ⅰ期HE前三者為Ⅱa、Ⅲb和Ⅰ型，髮生Ⅱ期HE的前三者為Ⅱb、Ⅲb和Ⅰ型；術後3箇月時髮生MHE的前三者為Ⅲa、Ⅱa和Ⅱc型，髮生Ⅰ期HE的前三者為Ⅲa、Ⅱb和Ⅳ型，髮生Ⅱ期HE的前三者為Ⅱa、Ⅱb和Ⅲb型；術後6箇月時髮生MHE的前三者為Ⅱa、Ⅱc和Ⅲb型，髮生I期HE的前三者為Ⅱb、Ⅰ和Ⅲb型，髮生Ⅱ期HE的前三者為Ⅱb、Ⅲb和Ⅰ型；且Ⅱb、Ⅲb和Ⅰ型TIPS術後HE持續時間較長。結論建立閤理的慢性門靜脈繫統血栓解剖分型可以有效的指導臨床TIPS的應用，術後HE在單純門靜脈主榦和單純腸繫膜上靜脈血栓中的髮生概率較高。
목적：통과건립만성문정맥혈전해부분형지도림상TIPS조작，탐토분석불동류형문정맥혈전술후간성뇌병（HE）적발생여TIPS술식선택적관계。방법2010년6월-2013년6월수치만성문정맥혈전환자73례，행Fluency복막지가TIPS치료。근거문정맥계통혈전불동부위，건립문정맥계통혈전해부분형，평고TIPS수술전후문정맥압력변화、불동류형혈전환자접수TIPS치료후15 d화3、6개월출현HE상황급병례수，병진행동일시간조간화불동시간변화대비。결과 TIPS치료중Ⅰ형환자적분류전、후적문정맥압력분별위（42．7±9．6）화（35．0±6．7）cm H2O，차이유통계학의의（P<0．01）；Ⅱ형환자분별위（39．8±5．5）화（31．0±5．7）cm H2O，차이유통계학의의（t =17．2，P <0．01）；Ⅲ형환자 TIPS 분별위（43．2±5．8）화（32．4±5．0）cm H2O，차이유통계학의의（t =25．0，P <0．01）；Ⅳ형환자분별위（43．0±3．7）화（36．6±6．6）cm H2O，차이유통계학의의（t=4．26，P<0．01）。술후15 d시발생경미HE（MHE）적전삼자위Ⅳ、Ⅰ화Ⅲb형，발생Ⅰ기HE전삼자위Ⅱa、Ⅲb화Ⅰ형，발생Ⅱ기HE적전삼자위Ⅱb、Ⅲb화Ⅰ형；술후3개월시발생MHE적전삼자위Ⅲa、Ⅱa화Ⅱc형，발생Ⅰ기HE적전삼자위Ⅲa、Ⅱb화Ⅳ형，발생Ⅱ기HE적전삼자위Ⅱa、Ⅱb화Ⅲb형；술후6개월시발생MHE적전삼자위Ⅱa、Ⅱc화Ⅲb형，발생I기HE적전삼자위Ⅱb、Ⅰ화Ⅲb형，발생Ⅱ기HE적전삼자위Ⅱb、Ⅲb화Ⅰ형；차Ⅱb、Ⅲb화Ⅰ형TIPS술후HE지속시간교장。결론건립합리적만성문정맥계통혈전해부분형가이유효적지도림상TIPS적응용，술후HE재단순문정맥주간화단순장계막상정맥혈전중적발생개솔교고。
Objective To establish an anatomical classification of chronic portal vein thrombosis (PVT) in order to guide the transjugular intrahepatic portasystemic shunt (TIPS) manipulation, and to analyze the correlation between anatomical classification of PVT and the occurrence of hepatic encephalopathy (HE) after TIPS. Methods During the period from June 2010 to June 2013 at authors’ hospital, TIPS with fluency covered stent was carried out in a total of 73 patients with chronic portal vein thrombosis. Based on the location of portal vein thrombosis, the anatomical classification of portal vein thrombosis (PVT-type) was initially established. The changes in portal vein pressure after TIPS were evaluated. The occurrence of HE at 15 days and at 3 and 6 months after TIPS in patients with different PVT-type was statistically analyzed. As the understanding of 0-phase minimal hepatic encephalopathy (MHE) was deepened, the authors added a subdivision to the 0-phase, including normal cognitive function state and minimal hepatic encephalopathy (MHE) into West - Haven grading to further precisely assess the hepatic encephalopathy. Using paired samples t-test, the changes of portal vein pressure after TIPS were evaluated. The grading of hepatic encephalopathy and the number of occurrence after TIPS were particularly recorded, the results were compared between groups at the same time and between the types at different times. Results The preoperative and postoperative portal vein pressure in type Ⅰ patients receiving TIPS therapy was (42.7 ± 9.6) and (35.0 ± 6.7) cm H2O respectively, the difference was statistically significant (t = 7.61, P <0.01);in typeⅡpatients it was(39.8 ± 5.5) and(31.0 ± 5.7) cm H2O respectively(t=17.2, P<0.01);in type Ⅲpatients it was (43.2 ± 5.8) and (32.4 ± 5.0) cm H2O respectively (t = 25.0, P < 0.01); and in type Ⅳpatients it was (43.0 ± 3.7) and (36.6 ± 6.6) cm H2O respectively (t = 4.26, P <0.01). The occurrence of HE 15 days after TIPS was mainly seen in patients with type Ⅳ , Ⅰ and Ⅲb. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with PVT-type Ⅱa, Ⅲb and type Ⅰ. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with PVT-type Ⅱb, Ⅲb and type Ⅰ. Three months after TIPS, the occurrence of MHE was mainly seen in patients of Ⅲa, Ⅱa and Ⅱc type. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with Ⅲa, Ⅱb and Ⅳ type. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with PVT-typeⅡa,Ⅱb andⅢb. Six months after TIPS, the occurrence of MHE was mainly seen in patients of type Ⅱa, Ⅱc and Ⅲb. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with type Ⅱb, Ⅰ and Ⅲb. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with typeⅡb,Ⅲb andⅠ. The HE condition lasted for longer time in patients withⅡb,Ⅲb andⅠtype. Conclusion The establishment of a rational anatomical classification for chronic portal vein thrombosis can effectively guide the clinical application of TIPS. The occurrence of postoperative hepatic encephalopathy is higher in patients with pure main portal vein thrombosis or superior mesenteric vein thrombosis.
