超声引导下门静脉穿刺导引经颈静脉肝内门体分流术联合曲张静脉栓塞治疗食管胃底静脉曲张破裂出血的临床效果  

Clinical effect of ultrasound-guided portal vein puncture guided transjugular intrahepatic portosystemic shunt combined with varicose vein embolization in the treatment of esophageal gastric fundus varices rupture and bleeding

作　　者：林纲毅[1] 马洺远[1] 蔡宗洋 LIN Gang-yi;MA Ming-yuan;CAI Zong-yang(Department of Vascular Intervention,Shantou Central Hospital of Guangdong Province,Shantou515031,China)

机构地区：[1]广东省汕头市中心医院血管介入科,广东汕头515031

出　　处：《中国当代医药》2020年第7期113-116,共4页China Modern Medicine

摘　　要：目的探讨超声引导下门静脉穿刺导引经颈静脉肝内门体分流术(TIPS)联合曲张静脉栓塞治疗食管胃底静脉曲张破裂出血的临床效果。方法选取2015年12月~2018年1月我院收治的60例食管胃底静脉曲张破裂出血患者作为研究对象,采用随机数字表法分为观察组(n=30)和对照组(n=30)。对照组采用传统TIPS路径联合经皮胃底曲张静脉栓塞术(PTVE)治疗,观察组采用超声引导下门静脉穿刺导引TIPS联合曲张静脉栓塞治疗。比较两组的手术指标、治疗前后的肝脏血管情况及肝功能指标。结果观察组的分流道穿刺次数少于对照组,分流道穿刺时间和手术时间短于对照组,分流道穿刺成功率高于对照组,差异均有统计学意义(P<0.05)。观察组治疗后的门静脉内径、脾静脉内径、肝动脉流速低于对照组,门静脉流速、脾静脉流速、肝动脉血管阻力指数(RI)高于对照组,差异均有统计学意义(P<0.05)。观察组治疗后的清蛋白水平高于对照组,总胆红素和丙氨酸氨基转移酶水平低于对照组,差异均有统计学意义(P<0.05)。结论超声引导下门静脉穿刺导引TIPS联合曲张静脉栓塞治疗食管胃底静脉曲张破裂出血可减少分流道穿刺次数,缩短分流道穿刺时间和手术时间,提高分流道穿刺成功率,改善患者的肝脏血管情况及肝功能指标。Objective To explore the clinical effect of ultrasound-guided portal vein puncture guided transjugular intrahepatic portosystemic shunt(TIPS)combined with varicose vein embolization in the treatment of esophageal and gastric fundus varices rupture and bleeding.Methods Sixty patients with esophageal gastric fundus rupture and bleeding who were treated in our hospital from December 2015 to January 2018 were selected as the research subjects,they were divided into observation group(n=30)and control group(n=30)by random number table method.The control group was treated with traditional TIPS pathway combined with percutaneous transhepatic variceal embolization(PTVE),the observation group was treated with ultrasound guided portal vein puncture guided TIPS combined with varicose vein embolization.Surgical indicators,liver vascular conditions,and liver function indexes before and after treatment were compared between the two groups.Results The number of shunt punctures in the observation group was less than that in the control group,the length of the shunt puncture and surgery was shorter than that of the control group,the success rate of shunt punctures was higher than that of the control group,the differences were statistically significant(P<0.05).The portal vein diameter,splenic vein diameter and hepatic artery flow velocity in the observation group were lower than those in the control group,the portal vein velocity,splenic vein flow velocity and hepatic artery vascular resistance index(RI)were higher than those in the control group,the differences were statistically significant(P<0.05).The albumin level in the observation group after treatment was higher than that in the control group,the levels of total bilirubin and alanine aminotransferase were lower than those in the control group,the differences were statistically sig nificant (P<0.05). Conclusion Ultrasound-guided portal puncture-guided TIPS combined with varicose vein embolization for esophageal gastric fundus varicose rupture and bleeding can reduce the numbe

关 键 词：超声引导下门静脉穿刺导引经颈静脉肝内门体分流术 曲张静脉栓塞 食管胃底静脉曲张破裂出血 临床对照研究 

分 类 号：R722.152[医药卫生—儿科]