肝窦阻塞综合征患者行经颈静脉肝内门体分流术后 死亡原因分析.

Objective To investigate the clinical features and causes of death after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatic sinus obstruction syndrome (HSOS), as well as the prevention and treatment measures to further improve the survival rate of such patients. Methods A retrospective analysis was performed for 293 patients with HSOS who were admitted to Nanjing Drum Tower Hospital from January 2013 to December 2019, among whom 20 patients died after TIPS. General information, laboratory examination, and clinical treatment regimen were analyzed, and clinical indices and complications were compared at different stages of the disease. The paired t - test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank - sum test was used for comparison of non - normally distributed continuous data between groups. Results The mean survival time was 15.15 ± 4.21 weeks for the 20 patients who died, among whom there were 15 male patients and 5 female patients, with a mean age of 67.60 ± 7.01 years; there were 17 patients (85%) aged ≥ 60 years, and more than 90% of the patients had abdominal distention and oliguria. Among the 20 patients who died, 9 (45%) had chronic underlying diseases, and 5 (25%) had more than two underlying diseases. Portal venous pressure decreased from 21.67 ± 5.15 mm Hg before surgery to 8.17 ± 4.98 mm Hg after surgery (t = 10.318, P < 0.05). The levels of total bilirubin, direct bilirubin, and D - dimer were significantly higher than the normal values before surgery, and the re were significant increases in these levels on day 5 after surgery (Z = 3.823, 3.823, 2.756, all P < 0.05); the hemoglobin level, platelet count, and creatinine level tended to decrease on day 5 after surgery (t = 4.979, t = 2.147, Z = - 3.125, all P < 0.05). Three patients had hepatic encephalopathy before surgery, while 10 patients (50%) had hepatic encephalopathy after surgery. Causes of death included acute liver failure, infectious shock, and multiple organ failure syndrome (MODS). Conclusion The possible risk factors for death after TIPS in HSOS patients include underlying diseases, high bilirubin, and complications such as hepatic encephalopathy and renal dysfunction. Causes of death mainly include acute liver failure and MODS. Ultrasound and laboratory markers should be reexamined during anticoagulation therapy to identify the patients with progression to severe diseases as early as possible, and in case of progressive deterioration of indices, TIPS should be selected as early as possible to improve the survival rate and prognosis of such patients. In addition, hemobilia should be observed during and after surgery, and intervention measures should be adopted in time to further reduce mortality rate. [ABSTRACT FROM AUTHOR]