采用EVL或TIPS治疗肝硬化并发食管静脉曲张出血患者疗效及其预后分析  

Efficacy of esophageal variceal ligation and transjugular intrahepatic portosystemic shunt in treatment of patients with liver cirrhosis and esophageal varices bleeding

作　　者：李伟[1] 宋卫东[1] 谢巴图白音 Li Wei;Song Weidong;Xie Batu Baiyin(Division B,Department of General Surgery,Affiliated People’s Hospital,Inner Mongolia Medical University,Hohhot,010020,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学附属人民医院腹部外科B区,呼和浩特市010020

出　　处：《实用肝脏病杂志》2021年第5期629-632,共4页Journal of Practical Hepatology

基　　金：内蒙古自治区卫生和计划生育委员会科研项目(编号:201803086)。

摘　　要：目的探讨采用食管曲张静脉套扎术(EVL)和经颈静脉肝内门体分流术(TIPS)治疗肝硬化并发食管曲张静脉破裂出血(EVB)患者的疗效。方法2016年10月~2018年10月我院收治的74例肝硬化并发EVB患者,其中34例接受EVL治疗,另40例接受TIPS治疗,术后均随访2年。结果入组患者在急性出血被控制后,行EVL或TIPS治疗,均止血成功;在治疗后2 w,两组肝功能和血象变化无显著性差异(P>0.05);术后,EVL治疗的肝硬化并发EVB患者胸腹痛、恶心和发热等并发症发生率88.2%,显著高于TIPS处理组(40.0%,P<0.05);在2年的随访期间,术后两组患者EV再出血发生率比较,无显著性差异(41.2%对35.0%,P>0.05);EVL治疗组病死率为20.6%,与TIPS治疗组的10.0%比,无显著性差异(P>0.05)。结论采用EVL和TIPS均可作为治疗EVB的方法,但与EVL术相比,行TIPS治疗的肝硬化并发EVB患者并发症发生率更低,值得进一步研究。Objective The aim of this study was to observe the efficacy of esophageal variceal ligation(EVL)and transjugular intrahepatic portosystemic shunt(TIPS)in treatment of patients with liver cirrhosis(LC)and esophageal varices bleeding(EVB).Methods 74 patients with LC complicated by EVB were admitted to our hospital between October 2016 and October 2018,and the EVL was carried out in 34 cases and the TIPS was performed in 40 patients.All patients were followed-up for 2 years.Results The EVL and TIPS were successfully completed in our patients after emergent hemostasis;at the end of two weeks,there was no significant difference as respect to liver function index or peripheral blood parameters in the two groups(P>0.05);the incidences of post-operational complications in EVL-treated patients was 88.2%,much higher than 40.0%in TIPSintervened patients(P<0.05);during the two-year follow-up,the incidences of post-operational re-bleeding of esophageal varices were not significantly different between the two groups(41.2%vs.35.0%,P>0.05);the fatality rate in EVL-treated patients was 20.6%,not significantly different compared to 10.0%in patients who received TIPS(P>0.05).Conclusion The efficacy of EVL and TIPS in dealing with patients with EVB is similar,while taking the post-operational complications into consideration,we recommend the latter for priority,which warrants further investigation.

关 键 词：肝硬化 食管曲张静脉破裂出血 食管曲张静脉套扎术 经颈静脉肝内门体分流术 治疗 

分 类 号：R575.2[医药卫生—消化系统] R571.3[医药卫生—内科学]