急诊经颈静脉肝内门体静脉分流术治疗肝硬化静脉曲张出血的疗效分析  

Efficacy analysis of emergency transjugular intrahepatic portosystemic shunt in the treatment of varicealbleeding in liver cirrhosis

作　　者：张峰[1] 诸葛宇征[1] 李振磊[1] 张明[1] 张建武[1] 贺奇彬[1] 彭春艳[1] 蔡炜[1] 倪景斌[1] 王婷婷[1] 

机构地区：[1]南京大学医学院附属鼓楼医院消化科,210008

出　　处：《中华消化杂志》2014年第1期16-20,共5页Chinese Journal of Digestion

基　　金：基金项目：南京市卫生局重点课题（ZKX09020）

摘　　要：目的探讨急诊经颈静脉肝内门体静脉分流术（TIPS）治疗急性肝硬化食管胃静脉曲张破裂出血（EGVB）的可行性、安全性和疗效。方法回顾性分析12例行急诊TIPS治疗的肝硬化EGVB患者资料，并与90例行择期TIPS预防再出血的肝硬化患者相比较，观察止血成功情况、再出血情况、肝静脉门静脉压力梯度（HPPG）、肝功能、肝性脑病与死亡情况等。计量资料行t检验，计数资料行卡方检验，采用Kaplan—Meier生存曲线比较累积再出血率。结果12例患者急诊TIPS均成功实施，术后出血即止。其中8例患者行HPPG测定，术后[（15．8±5．9）mmHg，1mmHg=0．133hPa]较术前[（20．7±5．0）mmHg]下降明显，差异有统计学意义（t=4．022，P=0．005）。术前肝功能（CTP）评分为6．6±1．5，术后为6．5±1．3，差异无统计学意义（P〉0．05）。术后1周内，12例行急诊TIPS的患者中3例出现肝性脑病，择期TIPS组肝性脑病发生率为18％（16／90），两组差异无统计学意义（P〉0．05）。随访期内，11例随访的行急诊TIPS的患者中，1例出现再出血；择期TIPS组的再出血率为21％（19／90）；两组累积再出血情况比较差异无统计学意义（P〉0．05）。急诊TIPS组无死亡病例，择期TIPS组总体病死率为13％（12／90），其中EGVB及肝功能衰竭相关病死率为9％（8／90）。结论急诊TIPS治疗急性肝硬化EGVB安全可行，疗效令人满意。Objective To investigate the feasibility, safety and efficacy of emergency transjugular intrahepatic portosystemic shunt （TIPS） in the treatment of esophageal and gastric variceal bleeding （EGVB） in liver cirrhosis. Methods The clinical data of 12 patients with liver cirrhosis and EGVB undergoing emergency TIPS were retrospectively analyzed, and were compared with those of 90 patients with cirrhosis undergoing selective TIPS for preventing rebleeding. The haemostasis, rebleeding, hepatic- portal vein pressure gradient （HPPG）, liver function, hepatic encephalopathy and death were observed. The t-test was performed for measurement data, while Chi square test was used for counting data and Kaplan-Meier survival curves was used to compare the cumulative rebleeding rate. Results All emergency TIPS of the 12 patients were successful, the bleeding stopped after operation. Among them, eight patients underwent HPPG examination, which significantly decreased after operation （（15. 8 ± 5. 9） mmHg, 1 mmHg=0. 133 kPa） compared with that before operation （（20.7±5.0） mmHg） and the difference was statistically significant （t= 4. 022, P = 0. 005）. The liver function （Child-Turcotte Pugh, CTP） score was 6.6±1.5 before operation and 6.5±1.3 after operation, there was no significant difference （P2〉0.05）. Hepatic encephalopathy occurred in three patients of the 12 cases undergoing emergency TIPS within one week after operation. The rate of hepatic encephalopathy in selective TIPS group was 18% （16/90） andthere was no significant difference （P〉0.05）. During the follow-up period, rebleeding occurred in one patient of the 11 followed up cases undergoing emergency TIPS, while the cumulative rebleeding rate was 21% （19/90） in the selective TIPS group and there was no significant difference in cumulative rebleeding between two groups （P〉0.05）. There was no dead case in the emergency TIPS group while the overall mortality of selective TIPS group was 13% （12/90）, in which t

关 键 词：门体分流术 经颈静脉肝内 肝硬化 食管胃底静脉曲张 胃肠出血 

分 类 号：R657.3[医药卫生—外科学]