经颈静脉肝内门体分流术治疗食管-胃底静脉曲张破裂出血伴门静脉海绵样变的疗效分析  

Efficacy analysis of transjugular intrahepatic portosystemic shunt in the treatment of esophago-gastric variceal bleeding complicated with cavernous transformation of the portal vein

作　　者：尹晓春 张峰[1] 肖江强[1] 王轶[1] 张明[1] 诸葛宇征[1] Yin Xiaochun;Zhang Feng;Xiao Jiangqiang;Wang Yi;Zhang Ming;Zhuge Yuzheng(Department of Gastroenterology,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,210008

出　　处：《中华消化杂志》2021年第10期685-691,共7页Chinese Journal of Digestion

摘　　要：目的探讨经颈静脉肝内门体分流术(TIPS)治疗伴门静脉海绵样变(CTPV)的肝硬化食管-胃底静脉曲张破裂出血(EGVB)的安全性和有效性。方法回顾性分析2015年1月1日至2018年12月31日在南京大学医学院附属鼓楼医院接受TIPS治疗、伴(CTPV组)或不伴(非CTPV组)CTPV的肝硬化EGVB患者的临床资料。分析CTPV组和非CTPV组患者的手术技术成功率、支架通畅率、上消化道再出血率、肝性脑病发生率和生存率等。采用独立样本t检验、Mann-Whitney U检验、卡方检验进行统计学分析,采用Kaplan-Meier法进行生存分析。结果共筛选出37例行TIPS治疗且伴CTPV的肝硬化EGVB患者,其中10例(27.0%)患者TIPS术中门静脉穿刺失败而转内镜下治疗,技术成功率为73.0%;行TIPS治疗但不伴CTPV的肝硬化EGVB患者共460例,其中18例(3.9%)患者TIPS失败,技术成功率为96.1%。按照1∶2进行倾向性匹配,共54例患者被纳入非CTPV组。CTPV组患者TIPS治疗后门静脉压力从(28.9±5.1)mmHg(1 mmHg=0.133 kPa)降至(18.8±4.5)mmHg,差异有统计学意义(t=7.122,P<0.01)。中位随访时间(范围)为33个月(1~66个月),CTPV组和非CTPV组的1年累积支架通畅率(75.0%比86.8%)、上消化道再出血率(21.0%比10.0%)、肝性脑病发生率(34.8%比22.2%)和生存率(80.7%比88.9%)比较差异均无统计学意义(P均>0.05)。结论伴CTPV的肝硬化EGVB患者行TIPS治疗安全、有效,且不增高术后并发症发生率和远期病死率。Objective To explore the safety and efficacy of transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of esophago-gastric variceal bleeding(EGVB)complicated with cavernous transformation of portal vein(CTPV).Methods From January 1,2015 to December 31,2018,the clinical data of liver cirrhosis patients with EGVB and complicated with(CTPV group)or without(non-CTPV group)CTPV receiving TIPS at Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School were retrospectively analyzed.The success rate of operation,stent patency rate,recurrent bleeding rate,incidence and survival rate of hepatic encephalopathy of CTPV group and non-CTPV group were analyzed.Independent samples t test,Mann-Whitney U test and chi-square test were used for statistical analysis.Kaplan-Meier method was used for survival analysis.Results A total of 37 liver cirrhosis patients with EGVB and CTPV receiving TIPS treatment were screened out,among which 10 patients(27.0%)failed the portal vein puncture during the TIPS and switched to endoscopic treatment,the success rate was 73.0%.A total of 460 liver cirrhosis patients with EGVB and non-CTPV received TIPS treatment,among which TIPS in 18 patients(3.9%)was failed,and the success rate was 96.1%.With 1∶2 ratio propensity matching,54 patients were enrolled in non-CTPV group.In the CTPV group,after TIPS treatment,the average portal vein pressure decreased from(28.9±5.1)mmHg(1 mmHg=0.133 kPa)to(18.8±4.5)mmHg,and the difference was statistically significant(t=7.122,P<0.01).The median follow-up time was 33 months(1 to 66 months).There were no significant differences between the CTPV group and the non-CTPV group in one-year of cumulative stent patency rate(75.0%vs.86.8%),recurrent upper gastrointestinal bleeding rate of hepatic encephalopathy(21.0%vs.10.0%),the incidence of hepatic encephalopathy(34.8%vs.22.2%)and the survival rate(80.7%vs.88.9%)(all P>0.05).Conclusion TIPS is safe and effective in the treatment of liver cirrhosis patients with EGVB and CTPV,an

关 键 词：门体分流术 经颈静脉肝内 门静脉海绵样变性 食管胃底静脉曲张出血 安全性 疗效 

分 类 号：R575.2[医药卫生—消化系统]