经颈静脉肝内门体静脉分流术联合胃冠状静脉栓塞术治疗肝硬化门静脉高压症上消化道出血的疗效分析  

Transjugular intrahepatic portosystem shunt plus gastric coronary vein embolization for cirrhotics portal hypertension complicating upper gastrointestinal bleeding

作　　者：林秀清 吴伟[2] 金瑞放[2] 黄尔炯[2] 余保平[1] Lin Xiuqing;Wu Wei;Jin Ruifang;Huang Erjiong;Yu Baoping(Department of Gastroenterology,Ren min Hospital of Wuhan University, Wuhan 430060, China;Department of Gastroenterology,First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]武汉大学人民医院消化内科,430060 [2]温州医科大学附属第一医院消化内科,浙江省325000

出　　处：《中华普通外科杂志》2019年第3期217-221,共5页Chinese Journal of General Surgery

基　　金：温州市科技局资助项目(Y20150162,Y20160104).

摘　　要：目的评价经颈静脉肝内门体静脉分流术(transjugular intrahepatic portosystem shunt,TIPS)联合胃冠状静脉栓塞术(gastric coronary vein embolization,GCVE)治疗肝硬化门静脉高压症伴上消化道岀血的临床疗效.方法选择2014年1月至2017年5月间温州医科大学附属第一医院诊治的肝硬化门静脉高压症伴上消化道出血患者72例,分为TIPS组36例(仅TIPS术)和TIPS+E组36例(TIPS联合GCVE术),术后随访12个月.结果TIPS+E组治疗1个月后的门静脉内径[(1.21±0.08)cm比(1.26±0.09)cm]、门静脉压力[(23.9±2.l)cmH20比(25.1±2.2)cmH2O]和淤血指数[(0.06±0.03)cm/s比(0.08±0.03)cm/s]明显低于TIPS组,门静脉流速高于TIPS组[(42±6)cm/s比(38±7)cm/s],差异均有统计学意义(r=2.491、2.367,2.828,t=2.343,均P<0.05).术后TIPS+E组的Child-Pugh评分低于TIPS组,差异有统计学意义(7.9±1.4比8.6±1.6,t=2.O74,P=0.O42)。两组术后1个月肝性脑病发生率差异无统计学意义(17%比11%,χ2=0.465,P=0.496)。TIPS组和TIPS+E组的术后1年再出血发生率分别为14%和3%.TIPS+E组再出血风险低于TIPS组(P=0.041).TIPS组和TIPS+E组的术后1年通路阻塞发生率分別为17%和14%,差异无统计学意义(P=0.679).TIPS组和TIPS+E组的全因死亡率分别为8%和3%,差异无统计学意义(P=0.299).结论在治疗肝硬化门静脉高压症伴上消化道出血中应用TIPS联合GCVE可显著降低患者的再出血风险.Objective To evaluate the clinical efficacy of transjugular intrahepatic portosystem shunt ( TIPS) and gastric coronary vein embolization ( GCVE ) in the treatment of patients with cirrhosis, portal hypertension and upper gastrointestinal bleeding. Methods Froin Jan 2014 to May 2017 72 patients were enrolled and divided into the TIPS group (36 cases,receiving TIPS) and TIPS + E group (36 cases, by TIPS + GCVE ). Results Portal vein diameter (1.21 ± 0.08) cm rs.( 1.26 ± 0.09) cm, portal pressure (23. 9 ± 2. 1 ) cmH20 vs.( 25. 1 ± 2. 2 ) cmH20 and congestion index ( 0. 06 ± 0. 03 ) cm/s vs.(0. 08 ± 0. 03 ) after 1 month of treatment in TIPS + E group was significantly lower than the TIPS group, and the portal vein velocity was significantly higher than that of the TIPS group (42 ± 6 ) cm/s vs.( 38 ± 7) cm/s,t=2.491,2.367 , 2. 828 , t= 2. 343 ,all P<0. 05. The Child-Pugh score in the TIPS + E group was significantly lower than that in the TIPS group (7. 9 ± 1.4) vs. 8. 6 ± 1. 6, t =2. 074, P = 0. 042 ). There was no statistical! different difference in postoperative hepatic encephalopathy in the two groups ( 17% vs. 11%,χ2=0. 465 , P = 0. 496). The one-year rebleeding rates in the TIPS group and the TIPS + E group were 14% and 3%, respectively. The risk of rebleeding in the TIPS + E group was significantly lower than that in the TIPS group (HR =0. 218 , P = 0. 041 ). The one-year access obstruction rates in the TIPS group and the TIPS + E group were 17% and 14%, respectively.( P = 0. 679). The all-cause mortality rates of the TIPS group and the TIPS + E group were 8% and 3%, respectively, showing no statistically ( P = 0. 299). Conclusions TIPS + GCVE therapy in the treatment of portal hypertensive upper gastrointestinal bleeding effectively reduces the risk of rebleeding.

关 键 词：高血压 门静脉 门体分流术 经颈静脉肝内 栓塞 治疗性 

分 类 号：R657.34[医药卫生—外科学]