背景:自发性门体分流(SPSS)在肝硬化中很常见,并且随着肝功能恶化,其患病率增加,可能是门静脉高压恶化的结果,但没有实现对肝硬化并发症的有效保护。本研究旨在检测肝硬化患者门体分流的患病率并分析其对预后的影响。
方法:我们进行了一项前瞻性观察研究,其中92例失代偿期肝硬化患者根据病史进行评估,体检,生化检查和腹部计算机断层扫描(CT)血管造影结果。6个月后对肝硬化相关并发症的发展进行随访。
结果:在92例肝硬化患者中,57.6%的患者通过多探测器计算机断层扫描血管造影检测到SPSS(大SPSS小SPSS)。总的来说,我们在24例(26.1%)患者中发现了较大的SPSS,29例(31.5%)患者的SPSS较小,39例(42.4%)患者无分流。在分流中,脾肾分流是最常见的类型(25,27.2%),其次是脐旁分流(20.7%)。以前的代偿失调事件,包括肝性脑病,腹水,自发性细菌性腹膜炎和胃肠道出血,大型SPSS组,其次是小型SPSS组和无SPSS组。关于后续行动,大型SPSS患者(41.7%)的肝性脑病失代偿期发作频率高于小型SPSS患者(24.1%),其次是无SPSS患者(12.8%)。
结论:总之,所有肝硬化患者均应进行影像学检查,以检测是否存在门体分流.在一些情况下,SPSS较大的患者肝功能受损更严重,门静脉高压症的并发症也更常见.所以,这些患者可能会受益于更密切的监测和更强化的治疗.
Spontaneous portosystemic shunts (SPSS) are frequent in liver cirrhosis and their prevalence increases as liver function deteriorates, probably as a consequence of worsening portal hypertension, but without achieving an effective protection against cirrhosis complications. This study was conducted to detect the prevalence of portosystemic shunts in liver cirrhosis patients and analyze its prognostic role.
We conducted a prospective observational study, where 92 patients with decompensated cirrhosis were evaluated based on history, physical examination, biochemical tests and abdominal computed tomography (CT) angiography findings. A follow-up was done after six months for the development of cirrhosis-related complications.
Of the 92 cirrhotic patients, 57.6% had SPSS (large SPSS + small SPSS) detected by multi-detector computed tomographic angiography. Overall, we found large SPSS in 24 (26.1%) patients, small SPSS in 29 (31.5%) patients and no shunt in 39 (42.4%) patients. Among the shunts, the splenorenal shunt is the most frequent type (25, 27.2%) followed by the paraumbilical shunt (20.7%). Previous decompensating events, including hepatic encephalopathy, ascites, spontaneous bacterial peritonitis and gastrointestinal bleed, were experienced more frequently by the large SPSS group followed by the small SPSS and without SPSS groups. Regarding follow-up, decompensating episodes of hepatic encephalopathy developed more frequently in patients with large SPSS (41.7%) than in patients with small SPSS (24.1%) followed by patients without SPSS (12.8%).
In summary, all cirrhotic patients should be studied with radiological imaging to detect the presence of portosystemic shunts. In several cases, patients with large SPSS had a more impaired liver function and more frequent complications of portal hypertension. So, these patients would probably benefit from a closer surveillance and more intensive therapy.