摘要
目的 探讨经颈静脉肝内门体分流术 (TIPS)治疗肝硬化顽固性腹水的效果及其影响因素分析。方法 2 1例患者TIPS术后随访 5 0～ 132 3d(中位时间 337d) ,观察腹水 (腹围 )、临床血清学指标、支架通畅性、随访时间、生存率等。结果 在 1年的各个随访间期内 ,患者的腹水与术前比较均有明显改善 (P <0 .0 5 ) ,术后 3～ 6个月的完全有效率为 81% ,9～ 12个月的完全有效率为 91% ,单因素Logistic回归分析结果为肝硬化肝功能ChildC级与术后 3个月腹水疗效相关 (P <0 .0 5 ) ;TIPS术后血清钠 (Na+ )、肌酐 (Cr)与术前基线相比较 ,差异有显著性 (P <0 .0 5 )。患者 3、6个月病死率分别为14 %、2 0 % ,1年生存率为 72 % ;单因素COX回归分析显示年龄、肝功能Child分级、血清白蛋白、肝性脑病、血清总胆红素与术后预后相关 ;多因素COX回归仅显示肝性脑病、Child分级与预后相关。结论 TIPS是治疗顽固性腹水的有效方法 ;术前自身的肝功能情况决定腹水的疗效 ,而TIPS对于肝功能相对较好伴有肾功能衰竭的患者仍有效。
Objective To assess the clinical efficacy of TIPS in the treatment of patients with refractory ascites and investigate the clinical factors associated with TIPS. Methods 21 consecutive patients with refractory ascites, 16 men and 5 women with mean age of 45 years (range 22-69 years) were followed up for an average of 337 days (range 50-1323 days). Asites/ abdomen circumference, serum parameters, stents function, time of followed up and survival rate were analized. Results The ascites was significantly reduced as compared with basal values (P < 0.05). 81% and 91% patients had no or mild ascites during 3 to 6 months and 9 to 12 after TIPS respestively. According to responses to treatment within 3 months, using Logistic regression predicated the control of ascites with relation to Child class C for severe prognosis ( P<0.05 ). There were significant change in serum sodium, serum creatinine as compared with baseline at follow-up (P < 0.05). Their mortality were 14% during follow-up for 3 months, 20% in 6 and the survival rate was 72 % at 1 year. According to COX regression analysis showed that age, Child class C, serum albumin, hepatic encephalopathy, serum total bilirubin were related to severe prognosis; but only hepatic encephalopathy and Child class C had an effect on surivival rate. Conclusion TIPS is an effective method for refractory ascite caused by hepatitis cirrhosis, and also effective for patients with functional renal failure but retaining of liver compensation.
出处
《介入放射学杂志》
CSCD
2004年第1期11-14,共4页
Journal of Interventional Radiology
关键词
颈静脉
肝内门体分流术
顽固性腹水
TIPS
手术治疗
Ascite, refractory
Cirrhosis
Portosystemic shunt procedure
Transjugular intrahepatic
Radiology, interventinal
