内镜联合TIPS对肝硬化食管胃静脉曲张破裂出血的治疗观察  

Observation about Combinative Treatment of Endoscopy and TIPS for Cirrhosis Esophageal Gastric Varices Hemorrhage

作　　者：刘天宇[1] 何素玉[1] 姚勇[1] 龙晓奇 刘杰[1] 李前龙 粟春林 潘金[1] Liu Tianyu;He Suyu;Yao Yong(Digestive Center of Suining Central Hospital,Suining,Sichuan 629000,China)

机构地区：[1]遂宁市中心医院消化中心,四川遂宁629000

出　　处：《四川医学》2020年第11期1152-1157,共6页Sichuan Medical Journal

基　　金：2018年四川省医学科研课题(编号:S18014);遂宁市中心医院科研课题(编号:2019y15)。

摘　　要：目的探讨内镜治疗联合经颈内静脉肝内门体分流术对食管胃底静脉曲张破裂出血的疗效,分析并发症及其原因。方法收集我院2018年1月1日至2019年12月31日因肝硬化食管胃底静脉曲张破裂出血行TIPS或/和内镜下治疗的患者共217例次,其中A组(仅接受TIPS术)58例次,B组(仅接受内镜治疗)111例次,C组(接受内镜+TIPS治疗)48例次。比较患者接受不同治疗后的止血效果、术后静脉曲张程度、肝功能变化程度、再出血率及术后1年生存率。结果不同治疗方式均能在24 h内成功止血;C组在术后静脉曲张程度、肝功能维持、再出血率及术后1年生存率方面均优于其余两组,差异有统计学意义(均P<0.05)。B组术后食管胃静脉曲张缓解早期优于A组(P<0.05),但较A组和C组远期再出血率高(P<0.05)、并发症多(P<0.05)、1年生存率低(P<0.05)。结论内镜和经颈内静脉肝内门体分流治疗均可用于急诊止血;联合治疗较单一治疗方式在减少复发、维持肝功能、减少并发症和提高生存率方面具有显著作用。Objective To investigate the efficacy of combinative treatment of endoscopic operation and transjugular intrahepatic portosystemic shunt(TIPS)in esophageal and gastric variceal bleeding(EGVB),and analyze the cause of complication.Methods Data of 217 patients obtained from Suining central hospital were retrospectively analyzed,all patients were grouped into group A(only TIPS therapy),group B(only endoscopic operation therapy)and group C(combinative therapy of endoscopic operation and TIPS).Hemostatic effect,postoperative varicose degree,liver function change degree,rebleeding rate and postoperative 1-year survival rate were compared among groups.Result all different treatments can successfully stop the bleeding within 24 hours,Group C was superior to the other two groups in postoperative varicose degree,liver function maintenance,rebleeding rate and 1-year survival rate,and with statistically significant differences(all P<0.05).The early remission of esophageal and gastric varices in group B was better than that in group A(P<0.05),but the long-term rebleeding rate was higher(P<0.05),more complications(P<0.05),and the 1-year survival rate was lower(P<0.05).Conclusion Endoscopic operation and TIPS can be both used for emergency hemostasis of EGVB.Combinative therapy has more effect on reducing recurrence,maintaining liver function,reducing complications and improving survival rate than monotherapy.

关 键 词：肝硬化 静脉曲张 经颈内静脉肝内门体分流术 内镜治疗 肝功能 

分 类 号：R571.3[医药卫生—消化系统]