经颈静脉肝内门体支架分流术联合组织胶定位栓塞治疗食管胃底静脉曲张破裂出血中远期疗效评价  

Efficacy of transjugular intrahepatic portosystemic shunt combined with covered stent and coronary vein occlusion with TH glue for the treatment of gastroesophageal varices bleeding

作　　者：胡锦华[1] 王广川[1] 冯华[1] 吴蕾[1] 刘福利[1] 崔屹[1] 张春清[1] 权启镇[2] 

机构地区：[1]山东大学附属山东省立医院消化科,济南250021 [2]济南军区总医院消化科

出　　处：《中华消化病与影像杂志（电子版）》2013年第1期4-9,共6页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

基　　金：山东省科技攻关项目(2010G0020241)

摘　　要：目的评价经颈静脉肝内门体支架分流术（TIPS）联合组织胶定位栓塞治疗食管胃底静脉曲张破裂出血的中远期疗效。方法山东大学附属山东省立医院2005年1月至2011年12月收治89例肝硬化并食管胃底静脉曲张破裂出血患者。其中43例行单纯TIPS治疗（TIPS组），46例行TIPS联合组织胶定位栓塞治疗（TIPS＋CVO组）。测量、计算术前、术后两组患者直接门静脉压力（PVP）、门静脉压力梯度（PPG）。术前、术后TIPS组和TIPS＋CVO组间PVP、PPG比较应用t检验；TIPS组、TIPS＋CVO组术前与术后PVP、PPG比较应用t检验；随访期间TIPS组和TIPS＋CVO组患者未发生上消化道再出血率、生存率和支架通畅率分析应用Kaplan－Meier法，进一步组间比较应用log-rank检验。结果TIPS组、TIPS＋CVO组术前PVP分别为（35．21±3．12）、（34．33±3．59）mmHg（1mmHg=0．133kPa），术后PVP分别为（20．95±2．78）、（22．66±3．08）mmHg；TIPS组、TIPS＋CVO组术前PPG分别为（25．84±4．18）、（25．47±2．30）mmHg，术后PPG分别为（11．57±1．74）、（13．79±1．48）mmHg。两组患者术后PVP、PPG均较术前下降，且差异均有统计学意义（TIPS组：t=15．772、15．722，均P=0．000；TIPS＋CVO组：t=31．069、31．069，均P=0．000）；而术前、术后两组PVP差异均元统计学意义。术前两组PPG差异无统计学意义，而术后TIPS＋CVO组PPG高于TIPs组，且差异有统计学意义（t=－4．762，P=0．000）。术后随访1～84个月，平均（26．27±21．04）个月。TIPs组患者术后1年、2年和4年累积未发生上消化道再出血率分别为84．7％、70．8％和50．3％，而TIPS＋CVO组患者分别为95．5％、92．2％和86．8％，两组比较差异有统计学意义（X2=5．978，P：0．014）；TIPS＋CVO组患者术后6、12、24、48、60个月累积生存率分别为91．2％、87．8％、80．9％、64．3％、55．2％，TIPS组患者分别�Objective To prospectively compare rebleeding rates in patients treated with transjugular intrahepatic portosystemic shunt （TIPS） with covered stents alone and those treated with TIPS with covered stents combined with adjunctive coronary vein occlusion （ CVO ） with TH glue. Methods Eighty-ninepatients in Shandong Provincial Hospital Affiliated to Shandong University were admitted because of gastroesophageal varices bleeding from January 2005 to December 2011. All patients were divided into 2 groups： 43 cases in TIPS group, 46 cases in TIPS ＋ CVO group. Portal venous pressure（PVP） and portal pressure gradient（PPG） of the two groups before and after reatment were detected and compared using t test. In follow-up period, the free of upper gastronintestinal rebleeding rate, survival rate and stent patency rate of the two groups were analysed with Kaplan-Meier method, and further comoarison between grourps were anlysed using log-rank test. Results Preoperative PVP in TIPS group and TIPS ＋ CVO group were （35.21 ± 3.12） , （34.33± 3.59） mm Hg （ 1 mm Hg = 0. 133 kPa）, postoperative PVP were （20.95 ± 2.78 ）, （ 22.66 ± 3.08） mm Hg; preoperative PPG in two groups were （25. 84 ± 4. 18） , （25. 47 ±2. 30） mm Hg, postoperative PPG were （ 11.57 ± 1.74） , （ 13.79 ± 1.48） mm Hg. Postoperative PVP and PPG were lower than preoperative PVP and PPG, and the differences were statistically significant （TIPS group： t = 15. 772, P = 0. 000, t = 15. 722, P = 0. 000 ; TIPS ＋ CVO group ： t = 31. 069, P = 0. 000, t = 31. 069, P = 0. 000） ; there were no significant differences in PVP between the two groups before and after treatment. Preoperative PPG had no significant difference between the two groups, but the difference of preoperative PPG between the two groups was statistically significant （ t = - 4. 762, P = 0. 000）. All the cases were followed up for 1 to 84 months after with an average of （26.27 ±21.04） months. The free of variceal rebleeding rates in TI

关 键 词：食管和胃静脉曲张 出血 经颈静脉肝内门体支架分流术 栓塞 治疗性 组织胶 治疗结果 

分 类 号：R575.2[医药卫生—消化系统]