肝硬化门静脉高压并发上消化道出血的3种手术方式比较分析  

Comparative clinical analysis of three surgical methods in patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding

作　　者：温建生 岳琨 吴智群[2] 路红娟 

机构地区：[1]陕西省铜川矿务局中心医院介入中心,陕西铜川727000 [2]第四军医大学附属唐都医院介入放射科,西安710038

出　　处：《临床肝胆病杂志》2016年第2期264-268,共5页Journal of Clinical Hepatology

摘　　要：目的比较经颈静脉肝内门体分流术(TIPS)、经皮经肝食管胃底静脉曲张栓塞术(PTVE)及TIPS联合胃冠状静脉栓塞术(GCVE)在肝硬化晚期门静脉高压患者并发上消化道出血治疗中的效果及优劣性。方法回顾性分析2012年1月-2014年10月于铜川矿务局中心医院行手术治疗的肝硬化晚期门静脉高压并发上消化道出血患者167例,根据手术方法不同分为TIPS组(n=56)、PTVE组(n=53)及TIPS联合GCVE组(n=58)。比较3组患者治疗的手术时间、术后恢复时间、住院费用,术后消化道曲张改善程度、再出血发生率、肝性脑病发生率、腹水消除率,门静脉相关指标(门静脉内径、门静脉流速、门静脉压力)及肝功能指标(ALT、AST、TBil、白蛋白)的不同。计量资料多组间比较采用方差分析,进一步两两比较采用SNK-q检验;计数资料组间比较采用χ2检验。结果 3组的手术时间、住院费用、术后再出血发生率及术后肝性脑病发生率比较,差异均有统计学意义(F值分别为13.85、12.53,P值均<0.05;χ2值分别为7.132、6.368,P值均<0.05)。其中,TIPS组与PTVE组的住院费用比较,差异有统计学意义(q=2.84,P<0.05);TIPS组与TIPS联合GCVE组的手术时间、住院费用、术后再出血发生率及术后肝性脑病发生率比较,差异均有统计学意义(q值分别为3.99、2.58,P值均<0.05;χ2分别为7.396、6.183,P值均<0.05);PTVE组与TIPS联合GCVE组的手术时间、住院费用、术后再出血发生率及术后肝性脑病发生率比较,差异均有统计学意义(q值分别为4.53、3.99,P值均<0.05;χ2分别为7.534、5.461,P值均<0.05)。结论 TIPS联合GCVE虽然手术时间较TIPS和PTVE长、住院费用高,但术后再出血及术后肝性脑病发生率显著降低。Objective To compare the effects of transjugular intrahepatic portosystemic shunt （ TIPS ）, percutaneous transhepatic variceal embolization （ PTVE）, and TIPS combined with gastric coronary vein embolization （ GCVE ） in patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding. Methods A total of 167 patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding who underwent surgical treatment in Tongchuan Mining Bureau Central Hospital from January 2012 to October 2014 were analyzed retrospectively and divided into TIPS group （56 patients）, VFVE group （53 patients）, and TIPS - GCVE group （58 pa- tients） according to the difference in surgical method. The time of operation, time to postoperative recovery, hospital costs, postoperative improvement in gastrointestinal varices, incidence of rebleeding, incidence of hepatic encephalopathy, ascites elimination rate, indices relat- ed to the portal vein （ diameter of the portal vein, portal vein velocity, portal venous pressure）, and liver function parameters （ ALT, AST, TBil, and Alb） were compared between the three groups. Comparison of continuous data between these groups was made by analysis of vari- ance, and pairwise comparison was made by SNK - q test; comparison of categorical data between these groups was made by chis - quare test. Results There were significant differences in the time of operation, hospital costs, incidence of postoperative rebleeding, and incidence of postoperative hepatic encephalopathy between the three groups （F = 13.85 and 12.53, respectively, X2 = 7. 132 and 6. 368, respectively, all P 〈0. 05）. The hospital costs showed a significant difference between the TIPS group and the PINE group （q = 2. 84, P 〈0. 05） ; there were significant differences in the time of operation, hospital costs, incidence of postoperative rebleeding, and incidence of postoperative hepatic encephalopathy between the TIPS group and the TIPS- GCVE group （q = 3.9

关 键 词：肝硬化 门静脉高压 食管和胃静脉曲张 门体分流术 经颈静脉肝内 栓塞 治疗性 

分 类 号：R575.2[医药卫生—消化系统] R573.2[医药卫生—内科学]