门静脉系统经脾与经肝入路出血并发症的比较
Comparison of Bleeding Complications between Transplenic versus Transhepatic Access of the Portal Venous System.
作者信息
Haddad Mustafa M, Fleming Chad J, Thompson Scott M, Reisenauer Christopher J, Parvinian Ahmad, Frey Gregory, Toskich Beau, Andrews James C
机构信息
Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo-West 2, Rochester, MN 55905.
Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo-West 2, Rochester, MN 55905.
出版信息
J Vasc Interv Radiol. 2018 Oct;29(10):1383-1391. doi: 10.1016/j.jvir.2018.04.033. Epub 2018 Aug 31.
PURPOSE
To evaluate the incidence of bleeding complications between transplenic (TS) and transhepatic (TH) access in portal venous interventions.
MATERIALS AND METHODS
Retrospective review of patients who underwent TS or TH access for portal venous system interventions from January 2000 to August 2017. Only procedures with clinical and laboratory follow-up were included (n = 148). Twenty-four TS procedures were performed in 22 patients, and 124 TH procedures were performed in 114 patients. The main indications were for angioplasty/stent, embolization of varices/shunt, or portal vein embolization, with no difference between the groups. Mean patient age and sex were not significantly different between the groups (P values .445 and .682, respectively). Mean follow up was 2.3 years (range 0.1-14.2). There was no significant difference between the international normalized ratio (P = .300) and platelets (P = .234) before the procedure between the 2 cohorts.
RESULTS
Technical success of vascular access and procedural success was achieved in 22/24 (91.6%) TS procedures and 120/124 (96.8%) TH procedures (P = .238). There was no significant difference in bleeding complications between the 2 groups (3/24 [12.5%] TS vs 10/124 [8.1%] TH; P = .44). There was no significant difference in major bleeding complications (SIR classification ≥ C; 1/24 [4.2%] TS vs 4/124 [3.2%] TH; P = .789).There was no significant difference in the hemoglobin before or after the procedure (g/dL), with average change -1.1 g/dL (range -3.4 to +1.0) in the TS group and 1.0 g/dL (range -4.5 to +1.9) in the TH group (P = .540). Finally, there was no significant difference in proportion of patients requiring blood transfusion after the procedure (P = .520), with 2 (8.3%) in the TS group requiring an average of 4 units (range 2-6) and 17 (13.7%) in the TH group requiring an average of 3.5 units (range 1-26).
CONCLUSIONS
These data suggest no significant difference in bleeding complications between TS and TH access for portal venous interventions.
目的
评估门静脉介入治疗中经脾（TS）和经肝（TH）入路出血并发症的发生率。
材料与方法
回顾性分析2000年1月至2017年8月期间接受TS或TH入路进行门静脉系统介入治疗的患者。仅纳入有临床和实验室随访的手术（n = 148）。22例患者进行了24例TS手术，114例患者进行了124例TH手术。主要适应证为血管成形术/支架置入、静脉曲张/分流栓塞或门静脉栓塞，两组之间无差异。两组患者的平均年龄和性别无显著差异（P值分别为0.445和0.682）。平均随访时间为2.3年（范围0.1 - 14.2年）。两组术前国际标准化比值（P = 0.300）和血小板（P = 0.234）无显著差异。
结果
24例TS手术中有22例（91.6%）实现了血管入路技术成功和手术成功，124例TH手术中有120例（96.8%）实现了成功（P = 0.238）。两组出血并发症无显著差异（TS组24例中有3例[12.5%]，TH组124例中有10例[8.1%]；P = 0.44）。严重出血并发症（SIR分类≥C）无显著差异（TS组24例中有1例[4.2%]，TH组124例中有4例[3.2%]；P = 0.789）。手术前后血红蛋白（g/dL）无显著差异，TS组平均变化-1.1 g/dL（范围-3.4至+1.0），TH组平均变化1.0 g/dL（范围-4.5至+1.9）（P = 0.540）。最后，术后需要输血的患者比例无显著差异（P = 0.520），TS组2例（8.3%）平均需要4个单位（范围2 - 6），TH组17例（13.7%）平均需要3.5个单位（范围1 - 26）。
结论
这些数据表明，门静脉介入治疗中TS和TH入路在出血并发症方面无显著差异。
Zotero 插件