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目的探讨经颈静脉肝内门腔静脉分流术(TIPS)中门静脉穿刺位置对术后长期疗效的影响。方法回顾性分析采用覆膜支架完成TIPS手术的171例患者。根据术中门静脉穿刺位置分为门静脉主干或分叉部(A组,n=88)、门静脉右支(B组,n=48)及门静脉左支(C组,n=35)。使用Kaplan-Meier分析曲线及Log-rank检验分析术后分流道通畅率、肝性脑病(HE)发生率及生存率。结果171例患者均成功建立门腔分流道,术后随访3~94个月,平均(35.23±18.91)个月;分流道狭窄率为29.82%(51/171);HE发生率为31.58%(54/171);死亡率为19.30%(33/171)。组间比较:(1)分流道狭窄率,C组与A组、B组的差异均有统计学意义(χ~2=11.49,P=0.001;χ~2=4.54,P=0.033),A组与B组的差异亦有统计学意义(χ~2=4.12,P=0.046);(2)HE发生率,C组与A组、B组的差异均有统计学意义(χ~2=8.07,P=0.004;χ~2=9.44,P=0.002)。3组术后死亡率差异无统计学意义(χ~2=0.364,P=0.834)。结论 TIPS术中选择门静脉左支建立门腔分流道,术后长期再狭窄率及HE发生率均较低。
Objective To investigate the effect of portal vein puncture position on long-term efficacy after transjugular intrahepatic portal venous shunt (TIPS). Methods A retrospective analysis of 171 patients with TIPS covered with stents was performed. According to the location of the portal vein in operation, they were divided into the main branch or branch of the portal vein (group A, n = 88), the right branch of the portal vein (group B, n = 48) and the left branch of the portal vein (group C, n = 35). Kaplan-Meier analysis and Log-rank test were used to analyze the rate of shunt patency, incidence of hepatic encephalopathy (HE) and survival rate. Results All the 171 patients were followed up for 3 ~ 94 months with an average of (35.23 ± 18.91) months; the stenosis rate was 29.82% (51/171); the incidence of HE was 31.58% 54/171); the mortality rate was 19.30% (33/171). The differences between the two groups were statistically significant (χ ~ 2 = 11.49, P = 0.001; χ ~ 2 = 4.54, P = 0.033), and the difference between the two groups was statistically significant There was also a significant difference between group B and group B (χ ~ 2 = 4.12, P = 0.046). (2) The incidence of HE was significantly different between group C and group A and group B (χ ~ 2 = 8.07, P = 0.004; χ ~ 2 = 9.44, P = 0.002). There was no significant difference in postoperative mortality between the three groups (χ ~ 2 = 0.364, P = 0.834). Conclusions The left branch of portal vein was selected to establish the portal shunt in TIPS. The long-term restenosis rate and the incidence of HE were low.