论文部分内容阅读
目的:探讨经颈静脉肝内门脉分流术(TIPS)后病人的远期分流道通畅率,生存期和生活质量。材料及方法:51例TIPS术后病人,随访时间平均为16.8±12.8月(1天-49月),用Kaplan-Meier法分析TIPS后病人的远期生存率,和分流道通畅率。用COX模型将生存期和通畅率与Child～Pugh肝功能分级和主要症状作相关分析,并预测影响生存期和分流道通畅率的因素。用SF～36问卷评估病人的生活质量。结果:1-4年累计生存率分别为65％,56％,32％,19％。累计原发通畅率分别为65％,56％,32％,19％。42个月原发再次通畅率为94％,18个月4继发通畅率为7l％。肝功能Child-Pugh分级与累积生存率有显著性差异。影响TIPS术后90天生存率的相关因素有:酒精性肝硬化,腹水,急性出血,分流腔道直径,静脉曲张需栓塞者,肝性脑病,分流通道再狭窄及再发出血。TIPS术后生活质量的所有9项指标均较术前提高,其中4项有显著性差异。结论:TIPS对控制出血,腹水及改善近期生活质量有肯定的疗效,但是对病人远期生活率的确切作用尚有待于进一步的研究。
Objective: To investigate the long-term shunt patency, survival and quality of life of patients after transjugular intrahepatic portal shunt (TIPS). MATERIALS AND METHODS: Totally 51 patients undergoing TIPS were followed up for a mean of 16.8 ± 12.8 months (ranged from 1 day to 49 months). The Kaplan-Meier method was used to analyze the long-term survival rate and shunt patency rate after TIPS. The COX model was used to correlate the survival and patency rate with Child Pugh classification of liver function and the main symptoms and to predict the factors influencing survival and patency rate. SF ~ 36 questionnaire to assess the quality of life of patients. Results: The 1- 4 years cumulative survival rates were 65%, 56%, 32% and 19% respectively. The cumulative primary patency rate was 65%, 56%, 32%, 19%. 42 months, the primary patency rate was 94%, 18 months, 4 secondary patency rate of 7l%. Liver function Child-Pugh classification and cumulative survival rates were significantly different. The factors that influence the 90-day survival rate of TIPS are: alcoholic cirrhosis, ascites, acute bleeding, diameter of shunt lumen, embolism of varicose veins, hepatic encephalopathy, shunt restenosis, and recurrent haemorrhage. All nine indicators of quality of life after TIPS were improved compared with that before operation, of which four were significantly different. Conclusion: TIPS has certain curative effect in controlling hemorrhage, ascites and improving the quality of life in the near future. However, the exact role of TIPS in the long-term survival of patients remains to be further studied.