颈静脉肝内门腔静脉分流术联合胃左静脉栓塞术对肝硬化食管胃底静脉曲张破裂出血患者再出血率和预后的影响  

Effect of jugular intrahepatic portacaval shunt combined with left gastric vein embolization on the rate of rebleeding and prognosis in patients with esophageal and gastric varices bleeding due to cirrhosis

作　　者：杨慧玲[1] 蔺淑梅[1] 张曦[1] 叶峰[1] YANG Hui-ling;LIN Shu-mei;ZHANG Xi;YE Feng(Department of Infections,first Affiliated Hospital of Xi’an Jiaotong University Shaanxi,Xi’an,710061)

机构地区：[1]西安交通大学第一附属医院感染科

出　　处：《现代消化及介入诊疗》2019年第7期722-726,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的 探讨颈静脉肝内门腔静脉分流术(TIPS)联合胃左静脉栓塞术(LGVE)对肝硬化食管胃底静脉曲张破裂出血(EGVB)患者再出血率和预后的影响。方法 选取本院2014年6月至2017年4月收治的116例EGVB患者,随机分为TIPS组与联合组,各58例。TIPS组采取TIPS治疗,联合组采取TIPS联合LGVE治疗。比较两组随访至2019年4月的再出血率、肝性脑病发生率、静脉曲张程度改善率、支架狭窄、生存率。结果 截至2019年4月,TIPS组与联合组的肝性脑病累积发生率分别为22.41%与17.24%,差异无统计学意义(P>0.05)。联合组累积再出血率为39.66%,显著低于TIPS组的58.62%(P<0.05)。治疗后6个月,联合组静脉曲张程度改善率89.66%,显著高于TIPS组的74.14%(P<0.05)。联合组随访期间累积狭窄率51.72%,显著低于TIPS组70.69%(P<0.05)。两组1年生存率与累积生存率的差异无统计学意义(P>0.05)。结论TIPS联合LGVE可降低EGVB患者再出血风险,减少支架狭窄与肝性脑病发生风险,效果优于单独TIPS治疗。Objective To investigate the effect of jugular intrahepatic portacaval shunt (TIPS) combined with left gastric vein embolization (LGVE) on the re-bleeding rate and prognosis of cirrhosis patients with esophageal and gastric varices bleeding (EGVB).Methods 116 patients with EVGB admitted to our hospital from June 2014 to April 2017 were randomly divided into TIPS group and combined group,58 cases each. The TIPS group adopts TIPS,and the joint group adopts TIPS combined with LGVE. The rebleeding rate,the incidence of hepatic encephalopathy,the improvement rate of varicose veins degree,the stent stenosis and the survival rate of follow-up to April 2019 were compared between the two groups. Results As of April 2019,the cumulative incidence of hepatic encephalopathy in the TIPS group and the combined group was 22. 41% and 17. 24%,respectively,and the difference was not statistically significant (P > 0. 05). The cumulative rebleeding rate was 39. 66% in the combined group,which was significantly lower than 58. 62% in the TIPS group (P < 0. 05). At 6 months after treatment,the improvement rate of varicose veins in the combined group was 89. 66%(52/58),which was significantly higher than 74. 14%(43/58) in the TIPS group,and the difference was statistically significant (P < 0. 05). The cumulative stenosis rate during the follow-up of the combined group was 51. 72%,which was significantly lower than 70. 69% of the TIPS group (P < 0. 05). There was no significant difference in 1-year survival rate and cumulative survival rate between the two groups (P > 0. 05). Conclusion TIPS combined with LGVE can reduce the risk of rebleeding in patients with EVGB,reduce the risk of stent stenosis and hepatic encephalopathy,and the effect is better than TIPS alone.

关 键 词：肝硬化 食管胃底静脉曲张破裂出血 颈静脉肝内门体分流术 胃左静脉栓塞术 再出血率 生存率 

分 类 号：R575.21[医药卫生—消化系统]