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目的探讨分析经颈静脉肝内门腔分流术治疗血吸虫性肝硬化门脉高压征疗效。方法选择2010年3月至2016年3月本院收治的血吸虫性肝硬化门静脉高压征患者58例,采用经颈静脉肝内门腔分流术(TIPS)治疗,观察手术临床疗效,并比较分析患者手术前后门脉压力、门脉压力梯度变、血清生化指标变化。结果本组58例患者中,均成功置入支架建立分流道,手术成功率为100.00%,随访期内,无患者死亡;患者术后门脉压力及门脉压力梯度均较术前显著降低(P<0.05);患者手术前后血小板计数、红细胞计数、天冬氨酸转氨酶、丙氨酸转氨酶、血清肌酐、尿素氮以及总胆红素水平均有显著差异(P<0.05);术后门脉压力降低幅度0~25%患者肝性脑病发生率显著高于门脉压力降低幅度≥25%患者(P<0.05);术后门脉压力降低幅度与支架狭窄发生率无明显相关(P>0.05)。结论经颈静脉肝内门腔分流术治疗血吸虫性肝硬化门脉高压征具有着显著的临床疗效,能够有效降低降低机体门脉压力及门脉压力梯度,并改善患者机体生化指标,而术后门脉压力降低幅度越低,术后肝性脑病发生率越高。
Objective To investigate the clinical effect of transjugular intrahepatic portosystemic shunt on the treatment of schistosomiasis cirrhosis and portal hypertension. Methods Fifty-eight patients with portal hypertension of schistosomiasis cirrhosis admitted in our hospital from March 2010 to March 2016 were treated with transjugular intrahepatic portosystemic shunt (TIPS), and the clinical curative effect was observed. The patients were compared and analyzed Portal pressure, portal pressure gradient change and serum biochemical indexes before and after operation. Results All the 58 patients were successfully placed into the stent to establish the shunt, the success rate was 100.00%. No patient died within the follow-up period. The postoperative portal pressure and portal pressure gradient were significantly lower than those before operation P <0.05). There were significant differences in platelet count, erythrocyte count, aspartate aminotransferase, alanine aminotransferase, serum creatinine, urea nitrogen and total bilirubin before and after operation (P <0.05) The incidence of hepatic encephalopathy in patients with 0-25% decrease in pressure was significantly higher than that in patients with ≥25% decrease in portal pressure (P <0.05). There was no significant correlation between postoperative decrease in portal pressure and incidence of stent stenosis (P> 0.05 ). Conclusion Transjugular intrahepatic portosystemic shunt for the treatment of schistosomiasis cirrhosis with portal hypertension has a significant clinical effect, which can effectively reduce the body portal pressure and portal pressure gradient, and improve the patient’s biochemical indicators, and postoperative The lower the decrease of portal pressure, the higher the incidence of postoperative hepatic encephalopathy.