中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2013年
7期
593-598
,共6页
许敏%周石%蒋天鹏%宋杰%安天志
許敏%週石%蔣天鵬%宋傑%安天誌
허민%주석%장천붕%송걸%안천지
肝硬化%放射学,介入性%对比研究
肝硬化%放射學,介入性%對比研究
간경화%방사학,개입성%대비연구
Liver cirrhosis%Radiology,interventional%Comparative study
目的 评价采用Fluency全覆膜支架行经颈静脉肝内门腔分流术(TIPS)治疗对肝硬化失代偿期患者肝肾功能及生存率的影响.方法 回顾性分析肝硬化失代偿期患者,采用完全随机法抽取其中成功行TIPS手术的48例作为治疗组,药物及内镜治疗的48例作为对照组.随访观察治疗前、治疗后1周、20 d、3个月、6个月、1年、2年和3年的肝肾功能实验室检查结果,并采用成组t检验或Wilcoxon秩和检验进行比较；采用Kaplan-Meier生存曲线统计患者3年内的生存率,并采用卡方检验比较.结果 术后第3年,对照组天冬氨酸转氨酶中位数为108.7 U/L,明显高于治疗组的70.8 U/L;对照组总胆红素中位数为76.2 μmol/L,治疗组为51.2 μmol/L,治疗组均优于对照组,差异均有统计学意义(Z值分别为-2.958和-2.004,P值均＜0.05).对照组治疗后第3年肌酐为(9928.2±2363.8) μmol/L,治疗组为(7742.1±2845.6) μmol/L,差异有统计学意义(t=-2.074,P＜0.05)；治疗组治疗后第1、2、3年的尿素氮分别为(2.0±1.1)、(2.3±1.5)和(2.5±1.3) mmol/L,均高于对照组,分别为(2.6±1.1)、(3.8±1.2)、(5.4±1.1)mmol/L,差异均有统计学意义(t值分别为-2.222、-3.940和-6.110,P值均＜0.05).2组患者生存率比较得出的Kaplan-Meier曲线3年生存率,治疗组为46.2％,对照组为30.0％,差异有统计学意义(x2=6.341,P＜0.05).结论 与药物联合内镜治疗相比,以Fluency全覆膜支架行TIPS手术可改善肝硬化患者的肝肾功能,提高生存率,是治疗肝硬化失代偿期患者安全有效的方式.
目的 評價採用Fluency全覆膜支架行經頸靜脈肝內門腔分流術(TIPS)治療對肝硬化失代償期患者肝腎功能及生存率的影響.方法 迴顧性分析肝硬化失代償期患者,採用完全隨機法抽取其中成功行TIPS手術的48例作為治療組,藥物及內鏡治療的48例作為對照組.隨訪觀察治療前、治療後1週、20 d、3箇月、6箇月、1年、2年和3年的肝腎功能實驗室檢查結果,併採用成組t檢驗或Wilcoxon秩和檢驗進行比較；採用Kaplan-Meier生存麯線統計患者3年內的生存率,併採用卡方檢驗比較.結果 術後第3年,對照組天鼕氨痠轉氨酶中位數為108.7 U/L,明顯高于治療組的70.8 U/L;對照組總膽紅素中位數為76.2 μmol/L,治療組為51.2 μmol/L,治療組均優于對照組,差異均有統計學意義(Z值分彆為-2.958和-2.004,P值均＜0.05).對照組治療後第3年肌酐為(9928.2±2363.8) μmol/L,治療組為(7742.1±2845.6) μmol/L,差異有統計學意義(t=-2.074,P＜0.05)；治療組治療後第1、2、3年的尿素氮分彆為(2.0±1.1)、(2.3±1.5)和(2.5±1.3) mmol/L,均高于對照組,分彆為(2.6±1.1)、(3.8±1.2)、(5.4±1.1)mmol/L,差異均有統計學意義(t值分彆為-2.222、-3.940和-6.110,P值均＜0.05).2組患者生存率比較得齣的Kaplan-Meier麯線3年生存率,治療組為46.2％,對照組為30.0％,差異有統計學意義(x2=6.341,P＜0.05).結論 與藥物聯閤內鏡治療相比,以Fluency全覆膜支架行TIPS手術可改善肝硬化患者的肝腎功能,提高生存率,是治療肝硬化失代償期患者安全有效的方式.
목적 평개채용Fluency전복막지가행경경정맥간내문강분류술(TIPS)치료대간경화실대상기환자간신공능급생존솔적영향.방법 회고성분석간경화실대상기환자,채용완전수궤법추취기중성공행TIPS수술적48례작위치료조,약물급내경치료적48례작위대조조.수방관찰치료전、치료후1주、20 d、3개월、6개월、1년、2년화3년적간신공능실험실검사결과,병채용성조t검험혹Wilcoxon질화검험진행비교；채용Kaplan-Meier생존곡선통계환자3년내적생존솔,병채용잡방검험비교.결과 술후제3년,대조조천동안산전안매중위수위108.7 U/L,명현고우치료조적70.8 U/L;대조조총담홍소중위수위76.2 μmol/L,치료조위51.2 μmol/L,치료조균우우대조조,차이균유통계학의의(Z치분별위-2.958화-2.004,P치균＜0.05).대조조치료후제3년기항위(9928.2±2363.8) μmol/L,치료조위(7742.1±2845.6) μmol/L,차이유통계학의의(t=-2.074,P＜0.05)；치료조치료후제1、2、3년적뇨소담분별위(2.0±1.1)、(2.3±1.5)화(2.5±1.3) mmol/L,균고우대조조,분별위(2.6±1.1)、(3.8±1.2)、(5.4±1.1)mmol/L,차이균유통계학의의(t치분별위-2.222、-3.940화-6.110,P치균＜0.05).2조환자생존솔비교득출적Kaplan-Meier곡선3년생존솔,치료조위46.2％,대조조위30.0％,차이유통계학의의(x2=6.341,P＜0.05).결론 여약물연합내경치료상비,이Fluency전복막지가행TIPS수술가개선간경화환자적간신공능,제고생존솔,시치료간경화실대상기환자안전유효적방식.
Objective To investigate the efficiency of transjugular intrahepatic portosystemic shunt (TIPS) with Fluency stent in improving the hepatic and renal function and survival rate in patients with decompensated cirrhosis.Methods The decompensated cirrhosis patients who were treated in our hospital from May 2008 to September 2011 were retrospectively analyzed.One group of patients (n =48) undergoing TIPS was randomly selected as treatment group,while another group of patients (n =48) treated by medicine and therapeutic endoscope was randomly chosen as control group.Clinical data and fellow-up data were retrospectively reviewed.There was no significant deviation in baseline characteristics (age,gender composition,etiology,renal function,hepatic function et al) among all the patients before the operations; The laboratory results of hepatic and renal function in 2 groups before and after operation (1 week,20 days,3 months,6 months,1 year,2 years,3 years) were recorded and compared with independent samples t-test or Wilcoxon rank sum test.The survival rates of two groups in 3 years were analyzed using Kaplan-Meier survival curve and compared with Chi-square test.Results Three years after the operation,there were significant differences between the treatment group and the control group in AST(70.8 vs.108.7 U/L,Z =-2.958,P ＜ 0.05) and TBIL (51.2 vs.76.2 μmol/L,Z =-2.004,P ＜ 0.05).The Cr value of the 3rd year after the treatment were (9928.2 ± 2363.8) in the the control group and (7742.1 ± 2845.6) μmol/L in the treatment group(t =-2.074,P ＜ 0.05).BUN of the 1st,2nd and 3rd years after the treatment were (2.0 ± 1.1),(2.3 ± 1.5),(2.5 ± 1.3) mmol/L in the treatment group,while it was (2.6 ± 1.1),(3.8 ±1.2),(5.4 ± 1.1)mmol/L in the control group.There was significant difference between the 2 groups (t =-2.222,-3.940 and-6.110,P ＜ 0.05).Comparing the survival rate in the 2 groups with Kaplan-Meier survival curve,the 3 year survival rate in the treatment group was 46.2％,while in the control group it was only 30.0％ (x2 =6.341,P ＜ 0.05).Conclusions Compared with medicine therapy and therapeutic endoscopy,TIPS with Fluency stent may improve the hepatic function,renal function and survival rate in liver cirrhosis patients.It is a safe and effective therapy choice for patients with decompensated cirrhosis.
