CAJ | 학술논문

目的：探讨使用覆膜支架行经颈静脉肝内门体静脉分流术（TIPS）治疗原发性肝癌合并门静脉高压的临床疗效。方法回顾性分析46例使用覆膜支架行 TIPS 治疗原发性肝癌合并门静脉高压症患者的临床资料，分析患者术后肝功能指标变化、分流道通畅率、再出血率、肝性脑病、腹水、胃肠道症状变化，以及术后生存期、死亡原因等。手术前后组间的计量资料比较采用配对 t 检验。采用生存曲线分析支架通畅率、肝性脑病发生率和生存率。结果手术后门静脉压力[（16．2±4．6）mmHg （1 mmHg＝0．133 kPa）]较手术前[（28．3±5．1）mmHg]明显降低，差异有统计学意义（t ＝21．30，P ＜0．05）。术后7 d 肝功能 Child-Pugh 评分为（6．9±1．5）分，与术前[（6．8±1．8）分]相比差异无统计学意义（P ＞0．05）。术后3、6、12、24、36个月覆膜支架分流道的累积通畅率分别是100．0％、95．6％、93．5％、91．3％、91．3％。肝性脑病的累积发生率分别为6．5％、8．7％、13．0％、17．4％、26．1％。累积生存率分别是95．7％、82．6％、67．4％、43．5％、32．6％。10例难治性腹水患者术后积液量均有不同程度减少，消化道不适症状明显减轻。结论对伴有门静脉高压的原发性肝癌患者，如果发生上消化道出血或顽固性腹水，使用覆膜支架行 TIPS 可有效降低门静脉压力，预防再发出血，减少腹水量。
목적：탐토사용복막지가행경경정맥간내문체정맥분류술（TIPS）치료원발성간암합병문정맥고압적림상료효。방법회고성분석46례사용복막지가행 TIPS 치료원발성간암합병문정맥고압증환자적림상자료，분석환자술후간공능지표변화、분류도통창솔、재출혈솔、간성뇌병、복수、위장도증상변화，이급술후생존기、사망원인등。수술전후조간적계량자료비교채용배대 t 검험。채용생존곡선분석지가통창솔、간성뇌병발생솔화생존솔。결과수술후문정맥압력[（16．2±4．6）mmHg （1 mmHg＝0．133 kPa）]교수술전[（28．3±5．1）mmHg]명현강저，차이유통계학의의（t ＝21．30，P ＜0．05）。술후7 d 간공능 Child-Pugh 평분위（6．9±1．5）분，여술전[（6．8±1．8）분]상비차이무통계학의의（P ＞0．05）。술후3、6、12、24、36개월복막지가분류도적루적통창솔분별시100．0％、95．6％、93．5％、91．3％、91．3％。간성뇌병적루적발생솔분별위6．5％、8．7％、13．0％、17．4％、26．1％。루적생존솔분별시95．7％、82．6％、67．4％、43．5％、32．6％。10례난치성복수환자술후적액량균유불동정도감소，소화도불괄증상명현감경。결론대반유문정맥고압적원발성간암환자，여과발생상소화도출혈혹완고성복수，사용복막지가행 TIPS 가유효강저문정맥압력，예방재발출혈，감소복수량。
Objective To investigate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with covered stent in the treatment of portal hypertension in patients with hepatocellular carcinoma.Methods The clinical data of 46 patients with primary hepatocellular carcinoma and portal hypertension who received TIPS with stent treatment were retrospectively analyzed.After treatment,liver function,shunt patency,re-bleeding rate,hepatic encephalopathy,ascites,gastric intestinal symptoms, lifetime and causes of death were analyzed. Compare t test was performed for measurement data comparison among groups.The survival curves were used to analyse the cumulative stent shunt patency rate,the incidence of hepatic encephalopathy and the survival rate.Results After the operation,portal vein pressure significantly decreased compared with that before operation [(16.2 ± 4.6 )mmHg vs (28.3±5 .1)mmHg,1 mmHg=0.133 kPa],and the difference was statistically significant (t =21 .30, P <0.05).There was no significant difference in liver function before and after operation [(6.8 ±1 .8) score vs (6.9±1 .5)score,P >0.05].Cumulative stent shunt patency at 3,6,12,24,36 month after operation was 100.0%,95 .6%,93.5 %,91 .3% and 91 .3%,respectively.The cumulative incidence of hepatic encephalopathy was 6.5 %,8.7%,13.0%,17.4% and 26.1 %,respectively;cumulative survival rate was 95 .7%,82.6%,67.4%,43.5 % and 32.6%,respectively.In 10 cases of refractory ascites, ascites of all the patients reduced with different degree after operation and gastrointestinal uncomfortable symptoms were relieved.Conclusion In patients with primary hepatocellular carcinoma and portal hypertension,who have gastrointestinal bleeding or refractory ascites,treatment of TIPS with covered stents could effectively lower portal pressure,prevent re-bleeding and reduce the volume of ascites.