脾肾分流术对肝硬化长期预后的影响。

Influence of splenorenal shunt on long-term outcomes in cirrhosis.

作者信息

Maruyama Hitoshi, Kondo Takayuki, Kiyono Soichiro, Sekimoto Tadashi, Takahashi Masanori, Yokosuka Osamu

机构信息

Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine , Chiba , Japan.

出版信息

Scand J Gastroenterol. 2015 May;50(5):593-600. doi: 10.3109/00365521.2014.1003401. Epub 2015 Jan 30.

DOI:10.3109/00365521.2014.1003401

PMID:25635924

Abstract

OBJECTIVE

To examine the clinical effect of splenorenal shunt (SRS) on the long-term outcomes in patients with cirrhosis.

METHODS

The study consisted of 162 cirrhosis patients (male 85, female 77; 62.6 ± 11.7 years). The clinical findings and prognosis were examined with respect to portal hemodynamics including collateral vessel patterns, with or without the presence of SRS or short gastric vein (SGV). Median observation period was 30 months.

RESULTS

The incidence was 18.5% for SRS and 10.5% for SGV. Decompensated cirrhosis was significantly more frequent in patients with SRS (22/30) than those with SGV (5/17, p = 0.0034), and in patients with SRS >5.5 mm (14/15) or >95 ml/min (14/15) (both, median values) than those with SRS <5.5 mm (8/15, p = 0.013) or <95 ml/min (8/15, p = 0.013). Cumulative overall survival rate was 87.4% at 1 year, 73.4% at 3 years, and 59.1% at 5 years. There was no significant difference in the cumulative survival rate according to the development of SRS: 80% at 1 year, 66.6% at 3 years, and 58.3% at 5 years in patients with SRS; 94.1% at 1 year, 87.4% at 3 years, and 72.8% at 5 years in patients with SGV; 88.3% at 1 year, 73.1% at 3 years, and 58% at 5 years in patients without SGV/SRS; 94.1% at 1 year, 87.4% at 3 years, and 72.8% at 5 years in patients with SGV (overall, p = 0.2).

CONCLUSION

In spite of no significant effect on the prognosis in cirrhosis, careful management may be necessary for the patients with SRS because of potential poor liver function demonstrated by the close linkage between the presence of SRS and decompensation.

摘要

目的

探讨脾肾分流术（SRS）对肝硬化患者长期预后的临床效果。

方法

本研究纳入了162例肝硬化患者（男性85例，女性77例；年龄62.6±11.7岁）。根据包括侧支血管模式在内的门静脉血流动力学情况，对有无SRS或胃短静脉（SGV）的患者的临床发现和预后进行了检查。中位观察期为30个月。

结果

SRS的发生率为18.5%，SGV的发生率为10.5%。SRS患者（22/30）的失代偿期肝硬化发生率显著高于SGV患者（5/17，p = 0.0034），SRS直径>5.5 mm（14/15）或血流量>95 ml/min（14/15）（均为中位数）的患者的失代偿期肝硬化发生率高于SRS直径<5.5 mm（8/15，p = 0.013）或血流量<95 ml/min（8/15，p = 0.013）的患者。1年累计总生存率为87.4%，3年为73.4%，5年为59.1%。根据SRS的发生情况，累积生存率无显著差异：有SRS的患者1年时为80%，3年时为66.6%，5年时为58.3%；有SGV的患者1年时为94.1%，3年时为87.4%，5年时为72.8%；无SGV/SRS的患者1年时为88.3%，3年时为73.1%，5年时为58%；有SGV的患者1年时为94.1%，3年时为87.4%，5年时为72.8%（总体，p = 0.2）。