發(fā)布時(shí)間：2018-06-04 11:42

  本文選題：經(jīng)頸內(nèi)靜脈肝內(nèi)門體分流術(shù) + 門脈高壓癥　； 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：探討經(jīng)頸靜脈肝內(nèi)門腔分流術(shù)（TransjugularIntrahepatic Portosystemic Shunt,TIPS）中建立門靜脈左支門腔分流道與右支門腔分流道對(duì)肝硬化門脈高壓癥患者術(shù)后肝性腦病發(fā)生的差異。方法：回顧性分析我院2012年3月-2014年3月收治37例門脈高壓所致上消化道出血，并行TIPS術(shù)患者。其中經(jīng)頸靜脈肝內(nèi)門靜脈左支門腔分流術(shù)患者組18例（左支組）和經(jīng)頸靜脈肝內(nèi)門靜脈右支門腔分流術(shù)組（對(duì)照組）19例。比較兩組門靜脈屬支血氨濃度差異及門靜脈壓力梯度（portal pressure gradient PPG）情況；技術(shù)成功率及術(shù)后6月分流道通暢率；對(duì)比術(shù)后第1天及術(shù)后第7天外周肘靜脈血氨濃度；術(shù)后6月肝性腦病發(fā)生率和生存率的差異等。結(jié)果：分流前，，兩組門靜脈系統(tǒng)中對(duì)應(yīng)同一屬支血氨濃度有差異，差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）；門靜脈系統(tǒng)中不同屬支間血氨濃度有差異，其中，腸系膜上靜脈高于門靜脈左支、右支，高于脾靜脈，門靜脈右支高于左支，且差異均具有統(tǒng)計(jì)學(xué)意義（P0.05）。兩組技術(shù)成功率均為100%。分流后，各組中PPG術(shù)后與術(shù)前比較差異均有統(tǒng)計(jì)學(xué)意義（P0.05），術(shù)后兩組間無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。術(shù)后第1天肘靜脈血氨濃度，左支組和對(duì)照組分別為(78.3+17.6)umol/L、(102.7+41.6)umol/L(P=0.024)；術(shù)后第7天肘靜脈血氨濃度(57.8+12.4)umol/L、(85.2+38.7)umol/L(P=0.007)。左支組術(shù)后第7天血氨濃度較術(shù)后第1天下降，差異有統(tǒng)計(jì)學(xué)意義（P0.001）；對(duì)照組術(shù)后第7天血氨濃度較術(shù)后第1日下降，差異無(wú)統(tǒng)計(jì)學(xué)意義（P=0.069）。術(shù)后隨訪6個(gè)月，兩組均未發(fā)生再出血，無(wú)死亡病例，分流道均通暢，組間生存率差異無(wú)統(tǒng)計(jì)學(xué)意義。左支組2例，對(duì)照組9例發(fā)生肝性腦病經(jīng)藥物治療緩解。結(jié)論：肝硬化門脈高壓癥患者門靜脈系統(tǒng)中各屬支血氨濃度存在差異,提示TIPS術(shù)中門靜脈左支、右支的選擇可能會(huì)影響患者術(shù)后肝性腦病的發(fā)生。選擇門靜脈左支作為TIPS的分流道,是安全可行的，可降低肝硬化門脈高壓癥患者術(shù)后血氨的上升幅度和肝性腦病的發(fā)生率，較選擇門靜脈右支作為TIPS的分流道有一定的優(yōu)勢(shì)，但在分流道通暢率、再出血率、生存率等方面二者無(wú)明顯差異。
[Abstract]:Objective: to investigate the difference of hepatic encephalopathy in patients with cirrhosis and portal hypertension after transjugular intrahepatic Portosystemic shunt (Transjugular intrahepatic Portosystemic shunt). Methods: from March 2012 to March 2014, 37 patients with upper gastrointestinal hemorrhage caused by portal hypertension were treated in our hospital and treated with TIPS. Among them, 18 patients (left branch group) and 19 patients (control group) underwent transjugular intrahepatic portal vein shunt (left branch group) and right portal vein shunt group (control group 19 cases). The blood ammonia concentration of portal vein branch and portal vein pressure gradient portal pressure gradient PPG) were compared between the two groups, the technical success rate and the patency rate of shunt duct in 6 months after operation were compared, and the blood ammonia concentration of elbow vein on the 1st and 7th day after operation was compared. Difference in incidence and survival rate of hepatic encephalopathy at 6 months after operation. Results: before shunt, there was significant difference in blood ammonia concentration between the two groups corresponding to the same branch of portal vein, but there was no significant difference in blood ammonia concentration between different branches of portal vein, in which the superior mesenteric vein was higher than the left branch of portal vein and the right branch. The right branch of portal vein was higher than the left branch, and the difference was statistically significant (P 0.05). The technical success rate of both groups was 100%. After shunt, there was significant difference between PPG and preoperation in each group (P 0.05), but there was no significant difference between the two groups after operation (P 0.05). On the first day after operation, the concentration of ammonia in the left branch group and the control group were 78.36 渭 mol / L ~ 102.7 渭 mol / L ~ (-1) ~ 102.7 渭 mol / L ~ (-1) P ~ (0.024), respectively, and on the 7th day after operation, the blood ammonia concentration of the cubital vein was 57.8 ~ (12.4) 渭 m / L ~ (-1) O / L ~ + ~ (85. 2) umoll / L ~ (-1) P ~ (0.007). In the left branch group, the blood ammonia concentration decreased on the 7th day after operation compared with that on the first day after operation, and the difference was statistically significant (P 0.001), while in the control group, the blood ammonia concentration on the 7th day after operation was lower than that on the first day after operation, and the difference was not statistically significant. After 6 months follow-up, there was no rebleeding, no death, no shunt and no significant difference in survival rate between the two groups. There were 2 cases in the left branch group and 9 cases in the control group. Conclusion: the concentration of ammonia in portal vein system of patients with portal hypertension is different, which suggests that the choice of left and right branches of portal vein during TIPS may influence the occurrence of hepatic encephalopathy after operation. It is safe and feasible to select the left portal vein as the shunt of TIPS. It can reduce the increase of blood ammonia and the incidence of hepatic encephalopathy in patients with cirrhosis and portal hypertension. It has some advantages over the right portal vein as the shunt of TIPS. However, there was no significant difference in shunt patency rate, rebleeding rate and survival rate between the two groups.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R575.21

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相關(guān)期刊論文 前3條

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本文編號(hào)：1977234