摘要
目的通过回顾性研究分析经颈静脉肝内门体静脉分流术(TIPS)后支架堵塞的影响因素,并探讨TIPS后抗凝治疗的必要性。方法回顾性统计山东省立医院2010年至2019年行TIPS手术的全部患者的基本信息、实验室检查结果、术前门静脉压力、术后抗凝时间、术后支架是否狭窄或堵塞等资料,并随访。对资料进行t检验、χ^(2)检验,及多因素logistic回归分析、COX多因素分析。结果最终共有280例患者纳入研究,其中发生支架狭窄或堵塞者110例(39.3%),支架畅通者170例(60.7%)。随访中明确是否有腹水新发或加重者共194例,其中支架狭窄或堵塞组中有14例(31.1%),支架通畅组19例(12.8%)。单因素分析中支架是否狭窄或堵塞与血小板(P=0.037)和总胆红素(P=0.038)相关,术前门静脉部分血栓患者术后持续抗凝与支架是否堵塞有一定相关性(P=0.029),术前存在门静脉海绵样变及术前门静脉通畅患者术后持续抗凝与支架是否堵塞无明显相关性(P=0.848;P=0.744)。多因素分析结果显示是否长期抗凝(P=0.017)、全因再出血(P<0.001)、术后显著肝性脑病(P=0.012)、术后新发或加重腹水(P<0.001)与术后支架是否堵塞相关,而血小板(P=0.134)、总胆红素(P=0.229)、国际标准化比值(P=0.436)、术后门静脉压力(P=0.230)与术后支架堵塞无关。结论对于术前发现门静脉部分血栓的患者,在TIPS后给予持续30 d的抗凝治疗可有效防止支架狭窄或堵塞;而对于术前门静脉通畅、门静脉海绵样变和术前门静脉完全堵塞的患者,术后是否抗凝对支架狭窄或堵塞无明显影响。
Objective To explore the necessity of anticoagulation therapy and influencing factors of stent occlusion after transjugular intrahepatic portosystemic shunt.Methods The basic information,laboratory test results,preoperative portal venous pressure,postoperative anticoagulation time,postoperative stent stenosis or occlusion,followed-up and other data of all patients who underwent TIPS surgery in Shandong Provincial Hospital from 2010 to 2019 were retrospectively analyzed.Data were analyzed using t-test,χ^(2) test,and multivariate analysis(logistic regression and Cox-regression-analysis).Results A total of 280 cases were finally included in the study,of which 110(39.3%)had stent stenosis or occlusion,and 170(60.7%)had stent patency.New or worsening ascites were identified in 194 cases during the follow-up period,including 14(31.1%)cases in the stent stenosis or occlusion group and 19(12.8%)cases in the stent patency group.Univariate analysis showed that presence or absence of platelet(P=0.037)and total bilirubin(P=0.038)were correlated with stent stenosis or occlusion.Postoperative continuous anticoagulation was correlated with stent blockage(P=0.029)in patients with partial portal vein thrombosis.Postoperative continuous anticoagulation and stent occlusions were not significantly correlated in patients with preoperative portal cavernoma and preoperative portal vein patency(P=0.848;P=0.744).Multivariate analysis results showed that whether long-term anticoagulation(P=0.017),all-cause rebleeding(P<0.001),postoperative significant hepatic encephalopathy(P<0.012),and postoperative new or worsening ascites(P<0.001)was significantly associated with stent occlusion(P<0.05),while platelets(P=0.134),total bilirubin(P=0.229),international normalized ratio(P=0.436),and portal vein pressure(P=0.230)were not significantly associated with stent occlusion after surgery.Conclusion In patients with partial portal vein thrombosis before surgery,continuous anticoagulation for 30 days post-TIPS therapy can effectively prevent stent stenosis or occlusion;while in patients with portal vein patency,portal cavernoma and complete portal vein blockage before surgery,postoperative anticoagulation has no significant effect on stent stenosis or occlusion.
作者
夏翊夫
宋丽君
王广川
黄广军
张春清
Xia Yifu;Song Lijun;Wang Guangchuan;Huang Guangjun;Zhang Chunqing(Department of Gastroenterology of Shandong Provincial Hospital,Shandong University,Jinan 250021,China;the Affiliated Weihai Second Municipal Hospital of Qingdao University,Qingdao 266000,China)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2022年第7期728-734,共7页
Chinese Journal of Hepatology
关键词
肝性脑病
经颈静脉肝内门体静脉分流术
抗凝治疗
支架堵塞
支架狭窄
血小板
术后再出血
腹水
Hepatic encephalopathy
Transjugular intrahepatic portosystemic shunt
Anticoagulation therapy
Stent blockage
Stent stenosis
Platelet
Rebleeding
Ascites
