经颈静脉肝内门体分流术联合部分脾动脉栓塞术治疗肝硬化并发门脉高压症患者门静脉血流动力学变化研究*

doi:10.3969/j.issn.1672-5069.2025.01.031

摘要/Abstract

摘要： 目的探讨经颈静脉肝内门体分流术(TIPS)联合部分脾动脉栓塞术(PSE)治疗肝硬化(LC)并发门脉高压症(PH)患者的疗效及其对门静脉血流动力学的影响。方法 2021年1月～2023年12月广东医科大学附属东莞第一医院介入治疗科和河南省人民医院综合介入科诊治的100例LC并发PH患者,被随机分为对照组47例和观察组53例,均接受TIPS术,观察组患者另接受PSE术,随访1年。采用ELISA法检测血清内皮素(ET)、血管紧张素Ⅱ(ATⅡ)和肾素活度(PRA),使用彩色多普勒超声诊断系统检测门静脉直径(PVD) 、门静脉血流量(PVF) 、脾静脉直径(SVD)和脾静脉血流量(SVF)。结果治疗后,观察组外周血白细胞、血小板和红细胞计数分别为(5.9±0.8)×10⁹/L、(93.7±14.0)×10⁹/L和(3.5±0.6)×10¹²/L,均显著高于对照组【分别为(3.4±0.4)×10⁹/L、(64.9±11.2)×10⁹/L和(3.1±0.2)×10¹²/L,P＜0.05】;观察组血浆ET、ATⅡ和PRA水平分别为(54.9±5.8)ng/L、(113.7±1.0)ng/L和(69.5±6.1)ng/L,均显著低于对照组【分别为(79.4±6.4)ng/L、(144.9±1.2)ng/L和(98.2±7.0)ng/L,P＜0.05】;观察组PVD、SVD和SVF分别为(12.1±3.0)mm、(9.4±0.6)mm和(275.9±37.6)ml/min,均显著小于或低于对照组【分别为(13.5±2.2)mm、(10.5±0.4)mm和(301.1±43.8)ml/min,P＜0.05】;术后随访1年,对照组分流道狭窄或闭塞、消化道出血和肝性脑病(HE)发生率分别为19.2%、2.1%和25.5%,观察组则分别为17.0%、0.0%和15.1%。结论采用TIPS联合PSE手术治疗LC并发PH患者能显著改善脾功能亢进症,降低消化道出血发生风险,但需注意防治HE并监测分流道通畅情况。

关键词: 肝硬化, 门脉高压症, 经颈静脉肝内门体分流术, 部分脾动脉栓塞术, 门静脉血流动力学, 治疗

Abstract: Objective The aim of this study was to investigate portal vein hemodynamic changes in patients with liver cirrhosis (LC) and portal hypertension (PH) after transjugular intrahepatic portal shunting (TIPS) and partial splenic artery embolization (PSE). Methods 100 patients with LC complicated with PH were encountered in First Affiliated Hospital, Guangdong Medical University and Comprehensive Interventional Department, Henan Provincial People's Hospital between January 2021 and December 2023, and were randomly divided into control (n=47) and observation group (n=53), and all patients in the two groups underwent TIPS and those in the observation received PSE after TIPS. All patients were followed-up for one year. Plasma endothelin (ET), angiotensin II (AT II) and renin activity (PRA) levels were assayed by ELISA, and portal vein diameter ( PVD), portal venous flow (PVF), splenic vein diameter(SVD) and splenic vein flow (SVF) were detected by ultrasonography. Results After treatment, peripheral white blood cell, platelet and red blood cell counts in the observation group were (5.9±0.8)×10⁹/L, (93.7±14.0)×10⁹/L and (3.5±0.6)×10¹²/L, all significantly higher than [(3.4±0.4)×10⁹/L, (64.9±11.2)×10⁹/L and (3.1±0.2)×10¹²/L, respectively, P＜0.05] in the control; plasma ET, ATⅡ and PRA levels were (54.9±5.8)ng/L, (113.7±1.0)ng/L and (69.5±6.1)ng/L, all significantly lower than [(79.4±6.4)ng/L, (144.9±1.2)ng/L and (98.2±7.0)ng/L, respectively, P＜0.05] in the control; PVD, SVD and SVF in the observation were (12.1±3.0)mm,(9.4±0.6)mm and (275.9±37.6)ml/min, all significantly smaller or lower than [(13.5±2.2)mm, (10.5±0.4)mm and (301.1±43.8)ml/min, respectively, P＜0.05] in the control; by end of one-year follow-up, incidences of shunt stenosis or occlusion, esophageal varice bleeding (EVB) and hepatic encephalopathy in the control group were 19.2%, 2.1% and 25.5%, and they were 17.0%, 0.0% and 15.1% in the observation group. Conclusion Combination of TIPS and PSE in dealing with patients with LC-induced PH could improve hypersplenism and reduce the risk of EVB, and we remind importance of surveillance of shunt patency.

Key words: Liver fibrosis, Portal hypertension, Transjugular intrahepatic portosystemic shunt, Partial splenic artery embolization, Portal venous hemodynamics, Therapy

王文栋, 梁茂全, 刘玉岩. 经颈静脉肝内门体分流术联合部分脾动脉栓塞术治疗肝硬化并发门脉高压症患者门静脉血流动力学变化研究^*[J]. 实用肝脏病杂志, 2025, 28(1): 120-123.

Wang Wendong, Liang Maoquan, Liu Yuyan. Portal vein hemodynamic changes in patients with liver cirrhosis and portal hypertension after transjugular intrahepatic portal shunting and partial splenic artery embolization[J]. Journal of Practical Hepatology, 2025, 28(1): 120-123.

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经颈静脉肝内门体分流术联合部分脾动脉栓塞术治疗肝硬化并发门脉高压症患者门静脉血流动力学变化研究^*

Portal vein hemodynamic changes in patients with liver cirrhosis and portal hypertension after transjugular intrahepatic portal shunting and partial splenic artery embolization

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