经颈静脉肝内门体分流术联合脾动脉栓塞对肝硬化患者肝脏血流动力学和肝功能的影响

梁晓华; 张峰; 诸葛宇征

doi:10.3969/j.issn.1001-5256.2016.11.021

经颈静脉肝内门体分流术联合脾动脉栓塞对肝硬化患者肝脏血流动力学和肝功能的影响

DOI: 10.3969/j.issn.1001-5256.2016.11.021

1. 南京医科大学
2. 南京大学医学院附属鼓楼医院消化科

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出版历程
- 出版日期: 2016-11-20

Effect of transjugular intrahepatic portosystemic shunt combined with splenic artery embolization on hepatic hemodynamics and liver function in patients with liver cirrhosis

摘要

摘要: 目的探讨经颈静脉肝内门体分流术（TIPS）联合脾动脉栓塞（SAE）对肝硬化患者肝脏血流动力学、肝功能以及预后的影响。方法收集2014年9月-2015年6月在南京鼓楼医院消化科行TIPS治疗的患者共24例,根据是否联合SAE分为TIPS组（n=14）和TIPS联合SAE组（n=10）,分别在治疗前后以彩色多普勒测量肝动脉和门静脉直径、血流速率和血流量,检测术前及术后肝功能（ALT、AST、TBil）,观察2组患者术后并发症（肝性脑病、脾脓肿）的发生情况。各组治疗前后指标的比较采用Wilcoxon检验,2组之间各指标的比较采用Mann-Whitney U检验。结果 TIPS联合SAE组术后5 d较术前肝动脉血流速率[200.00（168.25224.75）cm/s vs91.35（76.00113.25）cm/s]、门静脉血流速率[60.30（49.8575.70）cm/s vs 28.30（21.2030.00）cm/s]、肝动脉血流量[188.00（172.00232.00）m...
- 肝硬化 /
- 门体分流术,经颈静脉肝内 /
- 脾动脉栓塞 /
- 血流动力学
Abstract: Objective To investigate the effect of transjugular intrahepatic portosystemic shunt( TIPS) combined with splenic artery embolization( SAE) on hepatic hemodynamics,liver function,and prognosis in patients with liver cirrhosis. Methods A total of 24 patients who underwent TIPS in the Department of Gastroenterology in Drum Tower Hospital from September 2014 to June 2015 were enrolled and divided into TIPS group( 14 patients) and TIPS- SAE group( 10 patients) according to whether TIPS was used in combination with SAE. Color Doppler was used to measure the diameter,blood flow rate,and blood flow volume of the hepatic artery and portal vein before and after treatment; liver function parameters including alanine aminotransferase( ALT),aspartate aminotransferase( AST),and total bilirubin( TBil)were measured before and after surgery; the incidence of postoperative complications such as hepatic encephalopathy( HE) and splenic abscess was observed in the two groups. The Wilcoxon rank sum test was used for comparison of parameters before and after treatment within each group,and the Mann- Whitney U test was used for comparison of parameters between the two groups. Results At 5 days after surgery,the TIPS- SAE group showed significant increases in hepatic artery blood flow rate [200. 00( 168. 25- 224. 75) vs 91. 35( 76. 00-113. 25),Z = 2. 803,P = 0. 005],portal vein blood flow rate [60. 30( 49. 85- 75. 70) vs 28. 30( 21. 20- 30. 00),Z = 2. 666,P =0. 008 ],and hepatic artery blood flow volume [188. 00( 172. 00- 232. 00) vs 79. 10( 61. 15- 89. 75),Z = 2. 803,P = 0. 005],a significant reduction in portal vein pressure [29. 50( 24. 50- 34. 00) vs 38. 00( 34. 00- 41. 75),Z =- 2. 668,P = 0. 008],and significant increases in ALT [61. 30( 28. 55- 139. 60) vs 21. 10( 14. 00- 26. 95),Z = 2. 429,P = 0. 015],AST [43. 70( 22. 67- 106. 27) vs 23. 20( 20. 97- 36. 87),Z = 2. 599,P = 0. 009],and TBil [31. 75( 17. 95- 36. 92) vs 15. 35( 13. 10- 18. 62),Z = 2. 803,P = 0. 005]. The TIPS- SAE group showed a significantly higher level of AST at 30 days after surgery[49. 00( 12. 10 ~ 58. 35) U / L vs 23. 20( 20. 97 ~36. 87) U / L]( t = 2. 100,P = 0. 036). At 30 days after surgery,the TIPS group showed a significantly higher level of TBil than the TIPS-SAE group [35. 00( 24. 00- 51. 25) vs 18. 30( 12. 55- 31. 00),Z =- 2. 371,P = 0. 017]. At three month after surgery,one patient in the TIPS group developed HE( grade 2),and in the TIPS- SAE group,one patient experienced HE( grade 3) and 2 experienced splenic abscess. Conclusion After TIPS,hepatic artery infusion is significantly increased. SAE cannot further increase liver perfusion after TIPS;however,it may aggravate postoperative liver impairment within a short time and cannot improve the prognosis of patients.
- liver cirrhosis /
- portasystemic shunt,transjugular intrahepatic /
- splenic arterial embolization /
- hemodynamics

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参考文献(24)

[1] Experts Group from the Ministry of Heatth Special Fund for research in the Public Interest.Expert consensus on technical specification of treatment of portal hypertension with esophagogastric variceal bleeding C2013 edition[J].Chin J Dig Surg,2014,13(6):401-404.(in Chinese)卫生和计划生育委员会卫生公益性行业科研专项专家组.门静脉高压症食管胃曲张静脉破裂出血治疗技术规范专家共识(2013版)[J].中华消化外科杂志,2014,13(6):401-404.

[2]ZHAO JB,LI YH,HE XF,et al.Analysis on the incidence and impact factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene covered stent[J].Chin J Interv Imaging Ther,2013,10(2):85-88.(in Chinese)赵建波,李彦豪,何晓峰,等.聚四氟乙烯覆膜支架TIPS术后肝性脑病及其影响因素[J].中国介入影像与治疗学,2013,10(2):85-88.

[3]QI XS,BAI M,YANG ZP,et al.Selection of a TIPS stent for management of portal hypertension in liver cirrhosis:an evidence-based review[J].World J Gastroenterol,2014,20(21):6470-6480.

[4]XUE H,LI PJ,LI WZ,et al.Prevention and treatment of complications after transjugular intrahepatic portosystemic shunt[J].J Clin Hepatol,2016,32(2):238-241.(in Chinese)薛挥,李培杰,李伟之,等.经颈静脉肝内门体分流术的并发症及其防治[J].临床肝胆病杂志,2016,32(2):238-241.

[5]ZHENG LL,HAN GH,FAN DM.Role of transjugular intrahepatic portosystemic shunt in prevention and treatment of variceal bleeding in liver cirrhosis[J].J Clin Hepatol,2014,30(7):687-690.(in Chinese)郑鸾鸾,韩国宏,樊代明.经颈静脉肝内门体分流术在肝硬化静脉曲张出血防治中的地位[J].临床肝胆病杂志,2014,30(7):687-690.

[6]TUO L,TANG SH,ZENG WZ,et al.Treatment and prevention strategies to complications of transjugular intrahepatic portosystemic shunt[J].J Clin Hepatol,2016,32(2):354-357.(in Chinese)庹琳,汤善宏,曾维政,等.经颈静脉肝内门体分流术并发症的处理及预防措施[J].临床肝胆病杂志,2016,32(2):354-357.

[7]ZHU L,LI M,JIN MC,et al.Effects of portial spleenic embobization on hemodynamics in patients of liver cirrhosis with portal hypertention[J].J Nantong Univ:Med Sci,2010,30(2):124-125.(in Chinese)朱莉,李明,金满春,等.部分脾栓塞术对肝硬化患者门静脉血流动力学的影响[J].南通大学学报:医学版,2010,30(2):124-125.

[8]Chinese Society of Infectious Diseases and Parasitology,Chinese Society of Hepatology,Chinese Medical Association.Prevention and treatment of viral hepatitis[J].Chin J Infect Dis,2001,19(1):56-62.(in Chinese)中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志,2001,19(1):56-62.

[9]NOBUHISA A,YASUHIKO S,SHOUICHI S,et al.Hemodynamic changes in the hepatic circulation after the modulation of the splenic circulation in an in vivo human experimental model[J].Liver Transpl,2014,20(1):116-121.

[10]ZHANG HY,SUN JP,JIANG KH,et al.Correlation research of portal vein,hepatic artery and spleen venous blood flow mechanics and liver fibrosis[J].National Med Front China,2011,6(14):5-6.(in Chinese)张宏宇,孙建平,姜凯辉,等.门静脉、肝动脉和脾静脉血流动力学与肝纤维化相关性的研究[J].中国医疗前沿,2011,6(14):5-6.

[11]ZHANG L,DUAN YY,LI JM,et al.Doppler ultrasonographic evaluation on the correlation of portal pressure and inpendence indices of hepatic and splenic artery[J].China J Med Ultrasound,2008,5(1):41-46.(in Chinese)张莉,段云友,李金茂,等.超声检测门脉高压患者肝脾动脉阻抗指数与门脉压力相关性研究[J].中华医学超声杂志,2008,5(1):41-46.

[12]HOU Y,YANG JS,SUN GX,et al.Study on the plenic artery steal syndrome[J].Hebei Med J,2010,32(3):280-283.(in Chinese)侯钰,杨俊山,孙广新,等.脾动脉盗血综合征的临床研究[J].河北医药,2010,32(3):280-283.

[13]ZHAO KF,SHI RS.Research progress on hemodynamic of liver cirrhosis with portal hypertention[J].Hainan Med J,2014,25(18):2720-2722.(in Chinese)赵开飞,石荣书.肝硬化门静脉高压血流动力学研究进展[J].海南医学,2014,25(18):2720-2722.

[14]CHEN XY,WANG JP,LI BQ.The ultrasound evaluation of hemodynamic change of hepatic artery and portal vein in patients with hepatolenticular degeneration complicated with hypersplenism before and after splenectomy[J].J Bengbu Med Col,2013,38(8):1037-1039.(in Chinese)陈晓艺,王金萍,李保启.肝豆状核变性合并脾功能亢进患者脾切除前后入肝血管血流变化的超声评价[J].蚌埠医学院学报,2013,38(8):1037-1039.

[15]PRESSER N,QUINTINI C,TOM C,et al.Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients:a 5-year experience[J].Liver Transpl,2015,21(4):435-441.

[16]SAAD WE,ANDERSON CL,KOWARSCHIK M,et al.Quantifying increased hepatic arterial flow with test balloon occlusion of the splenic artery in liver transplant recipients with suspected splenic steal syndrome:quantitative digitally subtracted angiography correlation with arterial Doppler parameters[J].Vasc Endovascular Surg,2012,46(5):384-392.

[17]QUINTINI C,HIROSE K,HASHIMOTO K,et al.“Splenic artery steal syndrome”is a misnomer:the cause is portal hyperperfusion,not arterial siphon[J].Liver Transpl,2008,14(3):374-379.

[18]LIU Q,LI J,GUAN XD,et al.Hymodynamics study in rats with liver cirrhosis after portal vein arterialization associated with portocaval shunt[J].Chin Arch Gen Surg,2010,4(2):109-112.(in Chinese)刘琦,李坚,关晓东,等.入肝门静脉动脉化加门腔分流术对肝硬化大鼠血流动力学的影响[J].中华普通外科学文献,2010,4(2):109-112.

[19]SUN B.Dual-band Doppler ultrasound in the detection of blood supply from hepatic artery and portal vein in liver cirrhosis[J].J Chin Clin Med Imaging,2012,23(7):505-507.(in Chinese)孙博.超声双多普勒同时检测肝硬化肝动脉及门静脉血流供应研究[J].中国临床医学影像杂志,2012,23(7):505-507.

[20] WANG JM,LI SB.Hepatology[M].3rd.Beijing:People's Medical Publishing House,2013:32.(in Chinese)王家駹,李绍白.肝脏病学[M].3版.北京:人民卫生出版社,2013:32.

[21]YAO HM,LU SC.Splenectomy for recurrent hypersplenism after splenic arterial embolization[J].Chin J Hepatobiliary Surg,2011,17(4):283-284.(in Chinese)姚慧明,陆松春.脾动脉栓塞后脾亢复发再行脾切除术12例报告[J].中华肝胆外科杂志,2011,17(4):283-284.

[22]WANG MB,ZHANG HY,LU YL,et al.Chinical observation of partial splenic artery embolization in the treatment of portal hypertention[J].Hebei Med J,2011,33(15):2339.(in Chinese)

[23]QIAO ZY,GAO XM,YAN JB,et al.Ligation of splenic artery and gastric coronary vein trunk in treatment of emergent epatocirrhosis portal hypertention with upper gastrointestinal bleeding[J].J Bethune Medl Sci,2014,12(4):326-328.(in Chinese)乔自勇,高晓明,闫军波,等.脾动脉及胃冠状静脉主干结扎在肝硬化门静脉高压症上消化道出血中的应用[J].白求恩医学杂志,2014,12(4):326-328.

[24]RYSMAKHANOV M,DOSKALI M,TAGANOVA A,et al.Splenic artery embolization in patients after orthotopic liver transplant[J].Exp Clin Transplant,2015,13(3):52-54.

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