经颈静脉肝内门体分流术联合食管胃底静脉曲张栓塞术治疗门静脉高压胃底静脉曲张出血的临床研究  

A clinical study of transjugular intrahepatic portosystemic shunt combined with stomach and esopha-geal variceal embolization for gastric varices bleeding

作　　者：姜琴[1] 汪名权[1] 张国兵[1] 许建明[1] 孔德润[1] 

机构地区：[1]安徽医科大学第一附属医院消化内科,合肥230022

出　　处：《中华消化内镜杂志》2016年第3期168-173,共6页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金（81271736）

摘　　要：目的评估经颈静脉肝内门体分流术（TIPS）联合食管胃底静脉曲张栓塞术（SEVE）对门静脉高压胃底静脉曲张出血的治疗效果，并探讨伴和不伴胃肾分流道者间是否存在疗效差异。方法2013年10月至2015年3月，52例行TIPS联合SEVE治疗的门静脉高压胃底静脉曲张出血患者纳入研究，根据术前门静脉系统CTA检查结果分为胃底静脉曲张伴胃肾分流道组（A组）27例、胃底静脉曲张无胃肾分流道组（B组）25例，统计随访期间52例患者总体再出血率、总体支架通畅率、总体肝性脑病发生率及总体生存率，并行组间对比分析。结果52例患者平均门静脉压力由术前的（36．50±7．00）cmH20（1cmH20=0．098kPa）降至（28．15±6．27）cmH20，差异有统计学意义（t=10．357，P=0．001），术后随访1～18个月（A组1～18个月，B组1～15个月），总体再出血发生率为11．54％（6／52），总体支架通畅率为86．54％（45／52），总体肝性脑病发生率为11．54％（6／52），总体生存率为92．31％（48／52）。对比分析显示，A组和B组在术后再出血率[11．11％（3／27）比12．00％（3／25），P=1．000]、支架通畅率[88．89％（24／27）比84．00％（21／25），P=1．000]、肝性脑病发生率[14．81％（4／27）比8．00％（2／25），P=0．738]及生存率[92．59％（25／27）比92．00％（23／25），P=1．000]方面，差异均无统计学意义。结论TIPS联合SEVE治疗门脉高压胃底静脉曲张出血患者安全有效，且该技术治疗胃底静脉曲张出血伴胃。肾分流道患者与无胃肾分流道患者的临床疗效相似。Objective To evaluate the clinical efficacy of transjugular intrahepatic portosystemic shunt （TIPS） combined with stomach and esophageal variceal embolization（SEVE） for gastric variceal haem- orrhage,and the efficacy with or without a gastrorenal shunt. Methods A total of 52 patients with gastric variceal bleeding history and portal hypertension treated with TIPS combined with SEVE were included from October 2013 to March 2015.Patients were divided into two groups according to preoperateive CT angiogra- phy,27 cases with gastric variceal haemorrhage associated with a gastrorenal shunt in group A, and 25 gastric varices bleeding cases without gastrorenal shunt in group B. During the follow-up, the incidence of the total rates of rebleeding, TIPS primary patency and hepatic encephalopathy, and the survival rates were compared between group A and group B. Results In all patients, the average portal vein pressure decreased from 36. 50±7. 00 cmH20 （ 1 emil20=0. 098 kPa） before operation to 28. 15±6. 27 emH20 after TIPS combined with SEVE, with significant difference （t= 10. 357,P=0. 001）. Fifty two patients were followed up for 1 to 18 months（ 1-18 months in group A; 1-15 months in group B）.The total rates of rebleeding, TIPS primary patency, hepatic encephalopathy and survival were 11.54% （ 6/52）, 86. 54% （ 45/52）, 11.54% （6/52） and 92. 31% （48/52）, respectively. There were no significant differences between the two groups in the total rates of rebleeding [ 11.11% （ 3/27 ） VS 12. 00% （ 3/25 ）, P = 1. 000 ], TIPS primary patency [ 88.89% （24/27） VS 84. 00%（21/25）, P= 1. 000], hepatic encephalopathy[ 14. 81%（4/27） VS 8. 00%（2/25）, P= 0. 738 ] or total survival rate [ 92. 59% （ 25/27 ） VS 92. 00% （ 23/25 ）, P = 1. 000 ] after TIPS combined with SEVE. Conclusion TIPS combined with SEVE is effective for gastric varices, and equally effective in the treatment of both gastric variceal haemorrhage associated with a gastrorenal shunt and gastric varices ble

关 键 词：肝硬化 高血压 门静脉 门体分流术 经颈静脉肝内 食管胃静脉曲张 

分 类 号：R657.3[医药卫生—外科学]