南京医科大学学报（自然科学版）2026，Vol.46Issue(5)：691-699,9.DOI:10.7655/NYDXBNSN251466
肝硬化患者自发性门体分流行TIPS治疗的预后分析
Prognostic analysis of transjugular intrahepatic portosystemic shunt treatment for spontaneous portosystemic shunts in patients with cirrhosis
摘要
Abstract
Objective:To evaluate the prognosis of patients with combined non-esophagogastric variceal spontaneous portosystemic shunt(SPSS)undergoing transjugular intrahepatic portosystemic shunt(TIPS)combined with embolization.Methods:We performed a retrospective analysis of 603 cirrhotic patients who underwent TIPS at the First Affiliated Hospital of Nanjing Medical University between January 2018 and June 2024.After applying inclusion and exclusion criteria,patients were divided into two groups:the SPSS group(n=141)and the non-esophagogastric variceal SPSS group(Non-EGV-SPSS group,n=58).Baseline data,preoperative and postoperative portal vein pressure,intraoperative parameters,and postoperative outcomes(such as upper gastrointestinal rebleeding,stent dysfunction,hepatic encephalopathy,and survival prognosis)were collected and analyzed,Logistic regression analysis was employed to determine independent predictors of adverse prognosis.Results:During follow-up,64 patients(32.2%)developed overt hepatic encephalopathy.Rebleeding occurred in 42 cases(21.2%)of patients,among which 7 cases received endoscopic therapy,19 cases received interventional treatment,and 16 cases received medical treatment.Sixty-two cases(31.2%)died,among which 10 died of gastrointestinal rebleeding.The rebleeding risk of both groups was significantly associated with the reduction of portal pressure gradient(P=0.021).The Non-EGV-SPSS group exhibited a significantly higher rebleeding risk compared with the SPSS group(36.2%vs.14.9%,P=0.001).In contrast,no statistically significant differences were noted in mortality(36.2%vs.29.1%,P=0.400)or hepatic encephalopathy incidence(37.9%vs.29.8%,P=0.317)between the two groups.Age(HR=1.049,95%CI:1.020～1.079,P=0.001)and serum creatinine(HR=1.012,95%CI:1.002～1.023,P=0.017)were independent risk factors for post-operative hepatic encephalopathy.Pre-operative Non-EGV-SPSS was an independent risk factor for post-operative rebleeding;Age(HR=1.025,95%CI:1.002～1.047,P=0.030)and serum total bilirubin level(HR=1.002,95%CI:1.000～1.005,P=0.012)were independent risk factors for post-operative mortality.Conclusion:In cirrhotic patients undergoing TIPS,preoperative non-esophagogastric variceal SPSS is associated with an increased postoperative rebleeding risk,which correlates with changes in portal vein pressure.However,non-esophagogastric variceal SPSS does not significantly impact postoperative mortality or the incidence of hepatic encephalopathy.关键词
肝硬化/肝性脑病/非食管胃底静脉曲张/自发性门体分流/经颈静脉肝内门体分流术/栓塞Key words
cirrhosis/hepatic encephalopathy/non-esophagogastric varices/spontaneous portosystemic shunt/transjugular intrahe-patic portosystemic shunt/embolization分类
医药卫生引用本文复制引用
苏昊,吴必飞,杨魏,刘圣,施海彬,周卫忠..肝硬化患者自发性门体分流行TIPS治疗的预后分析[J].南京医科大学学报（自然科学版）,2026,46(5):691-699,9.基金项目
北京陈菊梅公益基金会(Z2026010285) （Z2026010285）
