巴西南部一家三级医院失代偿期肝硬化患者经颈静脉肝内门体分流术。
Transjugular intrahepatic portosystemic shunt in decompensated cirrhotic patients in a tertiary hospital in southern Brazil.
机构信息
Hospital Nossa Senhora da Conceição - Porto Alegre (RS), Brazil.
出版信息
Rev Assoc Med Bras (1992). 2023 Apr 14;69(4):e20220944. doi: 10.1590/1806-9282.20220944. eCollection 2023.
OBJECTIVE
The aim of the present study was to evaluate the outcomes of cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt.
METHODS
A retrospective longitudinal observational study was carried out evaluating 38 cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt. The outcomes were evaluated in an outpatient follow-up period of 3 months. The assumed significance level was 5%.
RESULTS
The indications for transjugular intrahepatic portosystemic shunt were refractory ascites in 21 (55.3%), variceal hemorrhage in 13 (34.2%), and hydrothorax in 4 (10.5%) patients. There was development of hepatic encephalopathy in 10 (35.7%) patients after transjugular intrahepatic portosystemic shunt. From the 21 patients with refractory ascites, resolution was observed in 1 (3.1%) patient, and in 16 (50.0%) patients, there was ascites control. Regarding transjugular intrahepatic portosystemic shunt after variceal bleeding, 10 (76.9%) patients remained without new bleeding or hospitalizations in the follow-up period. The global survival in the follow-up period in patients with and without hepatic encephalopathy was 60 vs. 82%, respectively (p=0.032).
CONCLUSION
Transjugular intrahepatic portosystemic shunt can be considered in decompensated cirrhotic patients; however, the development of hepatic encephalopathy which can shorten survival should be focused.
目的
本研究旨在评估接受经颈静脉肝内门体分流术的肝硬化患者的治疗效果。
方法
进行了一项回顾性纵向观察研究，评估了 38 例接受经颈静脉肝内门体分流术的肝硬化患者。在 3 个月的门诊随访期间评估了治疗结果。假设的显著性水平为 5%。
结果
经颈静脉肝内门体分流术的适应证为难治性腹水 21 例（55.3%）、静脉曲张出血 13 例（34.2%）和胸腔积液 4 例（10.5%）。术后 10 例（35.7%）患者发生肝性脑病。在 21 例难治性腹水患者中，1 例（3.1%）患者腹水得到缓解，16 例（50.0%）患者腹水得到控制。对于静脉曲张出血后行经颈静脉肝内门体分流术的患者，在随访期间，10 例（76.9%）患者未出现新的出血或再次住院。在随访期间，有和无肝性脑病患者的总体生存率分别为 60%和 82%（p=0.032）。
结论
可以考虑在失代偿期肝硬化患者中施行经颈静脉肝内门体分流术；然而，应关注肝性脑病的发生，因为其可能会缩短患者的生存时间。
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