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[目的]观察经颈内静脉肝内门体分流术(TIPS)治疗肝肾综合征(HRS)的临床疗效,探讨其可能的作用机制。[方法]10例确诊为HRS患者行TIPS,分别于术前及术后测门静脉压力、门静脉内径及血流速度、尿钠排泄、尿量、血肌酐(Cr)、尿素氮(BUN)及血Cr清除率;术前及术后7 d测定肾素(PRA)、血管紧张素Ⅱ(AT-Ⅱ)、醛固酮(ALD)水平。[结果]TIPS术后门静脉压力、门静脉内径及血流速度分别为(2.3±0.3)kPa、(1.26±0.04)cm、(44.2±14.5)cm/s,与术前比较均P<0.01。BUN、血Cr、尿钠排泄、血Cr清除率及尿量手术前后差异有统计学意义(均P<0.01)。术后PRA、AT-Ⅱ、ALD分别为(67.12±25.28)、(138.02±58.54)、(597.37±284.25)ng/L,与术前比较,P<0.01,<0.05,<0.05。[结论]TIPS治疗HRS近期疗效明显,其作用可能与血容量的增加和肾素-血管紧张素-醛固酮系统改变有关。
[Objective] To observe the clinical effect of transcatheter hepatic portal shunt (TIPS) on hepatorenal syndrome (HRS) and explore its possible mechanism. [Method] Tissue venous pressure, portal vein diameter, blood flow velocity, urinary sodium excretion, urine output, serum creatinine (Cr), blood urea nitrogen (BUN) and blood Cr clearance rates were measured before and 7 days after operation. The levels of renin (PRA), angiotensin Ⅱ (AT-Ⅱ) and aldosterone (ALD) were measured. [Results] The portal venous pressure, portal vein diameter and blood flow velocity after TIPS were (2.3 ± 0.3) kPa, (1.26 ± 0.04) cm and (44.2 ± 14.5) cm / s, respectively. BUN, blood Cr, urinary sodium excretion, blood Cr clearance and urine output before and after surgery were statistically significant (all P <0.01). The postoperative PRA, AT-Ⅱ and ALD were (67.12 ± 25.28), (138.02 ± 58.54) and (597.37 ± 284.25) ng / L, respectively, which were significantly lower than those before operation. [Conclusion] TIPS has obvious curative effect on HRS in short term, which may be related to the increase of blood volume and the change of renin-angiotensin-aldosterone system.