内镜治疗后食管胃底静脉曲张再出血TIPS疗效分析  

Effect of tips on rebleeding of gastroesophageal varices after endoscopic treatment

作　　者：黄向上 马秀现[1] 王志伟[1] 李健[1] Huang Xiangshang;Ma Xiuxian;Wang Zhiwei;Li Jian(Department of Hepatobiliary Surgery, The first affiliated hospital of Zhengzhou University, Zhengzhou 450003, Chin)

机构地区：[1]郑州大学第一附属医院肝胆外科,郑州450052

出　　处：《河南外科学杂志》2018年第3期1-3,共3页Henan Journal of Surgery

摘　　要：目的探讨内镜治疗后肝硬化门脉高压食管胃底静脉曲张(EGVB)再出血,经颈静脉肝内门体分流术(TIPS)的效果。方法回顾分析2012-10—2016-02间在郑州大学第一附属医院肝胆外科收治的42例EGVB经消化内镜治疗后仍出血的患者,全部进行TIPS治疗,分析治疗后的再出血率、静脉曲张消除率、分流道通畅率、死亡率、并发症等,观察TIPS术前后门脉压力及肝功能的变化。结果 42例患者共放入69枚覆膜支架、12枚裸支架,术后60 d、1 d再出血率分别为7.14%、18.57%,术后静脉曲张清除率为93.86%,术后2、6、12个月支架一期的累积通畅率分别为100.0%、98.6%、96.4%,死亡率为0;术后门静脉各压力梯度均低于手术前,差异有统计学意义(P<0.05);白蛋白(ALB)、血小板计数(PLT)明显低于手术前,差异有统计学意义(P<0.05),总胆红素(TBIL)治疗前后比较,差异无统计学意义(P>0.05);术后未发生严重并发症。结论 TIPS对于内镜治疗后肝硬化食管胃底静脉曲张仍再出血临床效果良好,对肝功能影响较少,对门脉系统血流动力学有一定影响,在肝功能较好的情况下可考虑行早期TIPS治疗。Objective To investigate the clinical effect of transjugular intrahepatic portosystemic shunt（ TIPS） on rebleeding after endoscopic treatment of cirrhosis and portal hypertension and esophageal varices（ EGVB）. Methods A retrospective analysis from 2012 to 201642 cases of EGVB admitted to Department of hepatobiliary surgery,the First Affiliated Hospital of Zhengzhou University,by digestive endoscopy treatment of hemorrhage,all patients treated by TIPS,analyze post treatment rebleeding,varices elimination rate,shunt patency rate,death rate and complications,to observe the changes of portal pressure and liver function of TIPS before and after operation. Results 42 patients were placed 69 pieces of membrane stent,12 nake stents,60 days 1 year after operation,the incidence of rebleeding was 7. 14%,18. 57%,the varicose vein removal rate was 93. 86%,postoperative cumulative patency 2,6,12 months after operation rate respectively is 100%,98. 6%,96. 4%,the death rate was 0; the postoperative portal vein pressure gradient were lower than that before surgery,the difference was statistically significant（ P 〈 0. 05）; liver function and blood platelet count,albumin（ ALB）,platelet count（ PLT） was significantly lower than that before surgery,the difference was statistically significant（ P 〈 0. 05）,total bilirubin（ TBIL） after treatment,there was no statistically significant difference（ P 〉 0. 05）; no serious postoperative complications occurred. Conclusion TIPS is effective for rebleeding after endoscopic treatment for esophageal and gastric varices. It has little effect on liver function and has a certain effect on portal hemodynamics. Early TIPS can be considered in patients with good liver function.

关 键 词：经颈静脉肝内门体分流术 食管胃底静脉曲张 内镜治疗后 肝功能分级 

分 类 号：R655.4[医药卫生—外科学]