改良经皮经肝食管胃曲张静脉栓塞术与经颈静脉肝内门体支架分流术治疗食管胃底静脉曲张破裂出血近期疗效比较  

Comparison on the recent curative effects of modified percutaneous transhepatic variceal emobolization and transjugular intrahepatic portosystemic shunt in the treatment of esophageal and gastric variceal bleeding

作　　者：王广川[1] 胡锦华[1] 冯华[1] 吴蕾[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内科

出　　处：《中华消化病与影像杂志（电子版）》2012年第6期8-13,共6页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的比较改良经皮经肝食管胃曲张静脉栓塞术(PTVE)及经颈静脉肝内门体支架分流术(TIPS)治疗食管胃底静脉曲张破裂出血的近期疗效。方法 2005年1月至2009年1月山东大学附属山东省立医院因肝硬化食管胃底静脉曲张破裂反复再出血行改良PTVE治疗46例患者(PTVE组)及行TIPS治疗38例患者(TIP组)。PTVE组、TIPS组患者术前、术后门静脉压力比较应用两独立样本t检验。PTVE组、TIPS组患者术前、术后不同时间肝功能(Child-Pugh评分、胆红素水平、白蛋白水平)比较应用ANOVA方差分析,进一步组间两两比较应用LSD-t检验;随访期内PTVE组、TIPS组患者再出血发生率、肝性脑病发生率及生存率应用Kaplan-Meier法分析,组间比较应用log-rank检验。结果 PTVE组患者术后门静脉压力由术前的(20.9±3.2)mm Hg(1 mm Hg=0.133 kPa)升至(22.7±4.2)mm Hg,但差异无统计学意义(t=1.683,P=0.58);TIPS组患者术后门静脉压力由术前的(20.2±2.4)mm Hg降至(10.6±2.3)mm Hg,且差异有统计学意义(t=5.421,P=0.0001)。PTVE组患者平均随访(36.0±12.4)个月,TIPS组患者平均随访(29.5±11.5)个月。PTVE组、TIPS组患者再出血发生率差异无统计学意义(29.8%vs 23.4%,χ2=5.36,P=0.631)。PTVE组患者肝性脑病发生率低于TIPS组患者,且差异有统计学意义(16.4%vs 55.7%,χ2=3.287,P=0.00)。PTVE组患者术后不同时间白蛋白水平均较术前升高,术后不同时间Child-Pugh评分均较术前降低,且差异均有统计学意义;而TIPS组患者术前、术后Child-Pugh评分、白蛋白水平差异均无统计学意义。PTVE组、TIPS组患者术后2年生存率差异无统计学意义(84.3%vs 66.3%,χ2=3.287,P=0.14)。PTVE组Child-Pugh C级患者术后2年生存率高于TIPS组Child-Pugh C级患者,且差异有统计学意义(76.0%vs 25.0%,χ2=4.671,P=0.02)。结论对于预防食管胃底静脉曲张破裂出血,改良PTVE与TIPS疗效相近。但PTVE术后肝性脑病发生率低,且有利于改善肝功能,同时Objective To compare the recent curative effects of the modified percutaneous transhepatic varieeal embolization （PTVE） with transjugular intrahepatic portosystemie shunt （TIPS） in the treatment of esophageal and gastric variceal bleeding, in order to evaluate the value of clinical application of the modified PTVE. Methods Cirrhotic patients with recurrent variceal bleeding from January 2005 to January 2009 were selected and assigned to PTVE （46 patients） and TIPS （38 patients） groups according to the procedures they received in Shandong Provincial Hospital Affiliated to Shandong University. The portal venous pressure （PVP） of pre- and post-operative in the PTVE and TIPS groups was compared using two sample t-test. Liver function （Child-Pugh score, bilirubin level, albumin level ） measured pre- and post-operative in different times were compared using ANOVA in the PTTE and TIPS groups, a further LSD-t test was applied for the further comparison between two groups. A Kaplan-Meier analysis was used to evaluate the variceal rebleeding rate, survival and the incidence of hepatic encephalopathy in the PTVE and TIPS groups during the follow-up period, and log-rank test was used for the further comparison between two groups. Results The mean PVP after PTVE raised from （ 20. 9 ±3.2）mmHg（lmmHg=0.133kPa）to （22.7± 4.2） mm Hg, but the difference was not statistically significant （ t = 1. 683, P = 0.58 ）. The mean PVP after TIPS reduced from （20.2± 2.4）mm Hg to （10.6 ±2.3）mm Hg, the difference was statistically significant （ t = 5. 421, P = 0. 0001 ）. The median follow-up period was （ 36.0 ±12.4） months and （29.5±11.5 ） months in the two groups, respectively. There was no significant difference in the rebleeding rate between the two groups （29.8% vs 23. 4%, X2 = 5.36, P = 0. 631 ）. The incidence of hepatic encephalopathy was lower in the PTVE group than that in the TIPS group, and the difference was statistically significant between the two groups （ 16.4%

关 键 词：肝硬化 食管和胃静脉曲张 经皮经肝食管胃曲张静脉栓塞术 经颈静脉肝内 门体支架分流术 

分 类 号：R575.2[医药卫生—消化系统]