经颈静脉肝内门体静脉分流术联合胃冠状静脉栓塞治疗门静脉高压症上消化道出血  

Treatment of variceal hemorrhage with transjugular intrahepatic portosystemic shunt combined with variceal embolization

作　　者：刘仕睿 丁鹏绪[1] 化召辉[1] 吴智慧[1] 黄必润[1] 徐鹏[1] 王志伟[1] 张文广[1] 李震[1] 

机构地区：[1]郑州大学第一附属医院腔内血管外科,450052

出　　处：《中华普通外科杂志》2015年第2期101-103,共3页Chinese Journal of General Surgery

摘　　要：目的 比较单独行经颈静脉肝内门体静脉分流术（transjugular intrahepatic portosystemic shunt,TIPS）与TIPS联合胃冠状静脉栓塞术治疗食管胃底曲张静脉破裂出血的再出血率.方法 回顾分析2009年1月至2013年4月间77例因肝硬化门静脉高压上消化道出血行TIPS手术治疗的患者,全部应用8 mm直径金属裸支架配合8 mm直径覆膜支架.24例患者单独行TIPS治疗,53例患者行TIPS联合胃冠状静脉栓塞治疗.结果 所有TIPS手术操作均成功完成.栓塞组与非栓塞组门静脉压力分别下降l0 mmHg和11 mmHg,两组门体压力梯度变化之间相比差异无统计学意义.非栓塞组24例患者中5例发生再出血（21％）,栓塞组53例患者中3例发生再出血（7％）,两组相比差异有统计学意义,χ^2=4.085,P=0.043;两组死亡率比较差异无统计学意义,χ^2=0.194,P=0.659.结论 TIPS联合胃冠状静脉栓塞较单独行TIPS可降低门静脉高压上消化道出血患者的术后再出血率.Objective To compare rebleeding rates following treatment of variceal hemorrhage with TIPS alone versus TIPS with variceal embolization in patients of gastroesophageal variceal bleeding.Methods In this retrospective study,77 patients with hepatic cirrhosis and variceal hemorrhage underwent TIPS insertion between 2009 and 2013.Generally,8 mm diameter TIPS were created using bare metal stents and covered stent-grafts simultaneously.A total of 24 patients underwent TIPS alone,while 53 patients underwent TIPS with variceal embolization.Results All TIPS were technically successful.Median portosystemic pressure gradient reductions were 10 mmHg versus 11 mmHg in the embolization and nonembolization groups.There were no statistically significant differences in portosystemic pressure gradients between the two groups.5/24（21%）patients in the TIPS alone group rebled while 3/53 （7%） patients in the TIPS with embolization group rebled during follow-up periods.A trend toward increased rebleeding rate was present in the TIPS alone group,χ^2 =4.085,P =0.043.Mortality （χ^2 =0.194,P =0.659） was not statistically different between the two groups.Conclusions TIPS combined with embolization of gastric coronary veins is more effective in the prevention of variceal rebleeding than TIPS alone.

关 键 词：高血压 门静脉 门体分流术 经颈静脉肝内 食管和胃静脉曲张 栓塞 治疗性 

分 类 号：R657.34[医药卫生—外科学]