经颈静脉肝内门体静脉分流术联合胃冠状静脉栓塞术和/或脾动脉栓塞术与单纯血管栓塞治疗对肝硬化门静脉高压性上消化道出血患者的效果  

Efficacy of Transjugular Intrahepatic Portosystemic Shunt Combined with Gastric Coronary Vein Embolization and/or Partial Splenic Embolization and Simple Vascular Embolization on Liver Cirrhotic Patients with Portal Hypertensive Upper Gastrointestinal Bleeding

作　　者：陈嘉欣 胡小波[2] 李庆刚 陈远思 刘丹[1] CHEN Jiaxin;HU Xiaobo;LI Qinggang;CHEN Yuansi;LIU Dan(Department of Gastroenterology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Infectious Diseases,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Endocrinology and Metabolism,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院消化内科,河南郑州450052 [2]郑州大学第一附属医院感染性疾病科,河南郑州450052 [3]郑州大学第一附属医院内分泌与代谢病科,河南郑州450052

出　　处：《河南医学研究》2022年第9期1551-1555,共5页Henan Medical Research

基　　金：河南省自然科学基金项目(212300410397)。

摘　　要：目的探讨以经颈静脉肝内门体静脉分流术(TIPS)联合胃冠状静脉栓塞术和/或脾动脉栓塞术与单纯血管栓塞治疗(胃冠状静脉和/或脾动脉栓塞术)对肝硬化门静脉高压性上消化道出血的疗效。方法回顾性分析郑州大学第一附属医院2017年1月至2019年9月收治的85例肝硬化门静脉高压性上消化道出血首次接受介入治疗的患者,根据治疗方法分为两组。以TIPS为主的分流组53例,接受TIPS联合胃冠状静脉栓塞术和/或脾动脉栓塞术;血管栓塞断流组32例,接受胃冠状静脉和/或脾动脉栓塞术。比较两组止血率、再出血率、肝功能指标、术后不良事件发生率(肝性脑病、死亡、追加手术)、生存率。结果以TIPS为主的分流组术后6、12个月再出血率低于血管栓塞断流组(P=0.007,P=0.049),术后追加手术率较低(P=0.006),但术后肝性脑病发生率高于血管栓塞断流组(P=0.001);与术前相比,以TIPS为主的分流组患者术后3、6、12、24个月总胆红素及碱性磷酸酶均升高(P<0.001),而血管栓塞断流组术后总胆红素及碱性磷酸酶未见升高。结论以TIPS为主的分流组再出血率低,而血管栓塞断流组长期维持肝功能的效果较好。Objective To investigate the effect of transjugular intrahepatic portosystemic shunt(TIPS)combined with gastric coronary vein embolization and/or partial splenic embolization and simple vascular embolization(gastric coronary vein embolization and/or partial splenic embolization)on upper gastrointestinal bleeding caused by portal hypertension in liver cirrhosis.Methods A retrospective analysis was performed on 85 patients of liver cirrhotic portal hypertension complicated with upper gastrointestinal bleeding and underwent the first interventional treatment at the First Affiliated Hospital of Zhengzhou University from January 2017 to September 2019.According to treatment methods,they were divided into 2 groups.53 patients in the shunt group dominated by TIPS underwent TIPS with gastric coronary vein embolization and/or partial splenic embolization,and 32 patients in the vascular embolization and devascularization group underwent gastric coronary vein and/or partial splenic embolization.The hemostasis rate,rebleeding rate,liver function index,the incidence rate of postoperative adverse events(hepatic encephalopathy,death,additional surgery)and survival rate were compared between the two groups.Results The rebleeding rate at 6 and 12 months after operation in shunt group dominated by TIPS were lower than those in vascular embolization and devascularization group(P=0.007,P=0.049),and the rate of additional operation after operation was low(P=0.006).However,the incidence of hepatic encephalopathy was higher than that of vascular embolization and devascularization group.Compared with pre-operation,the total bilirubin and alkaline phosphatase in shunt group dominated by TIPS were increased at 3,6,12 and 24 months after operation(P<0.001),while there was no increase in total bilirubin and alkaline phosphatase in vascular embolization and devascularization group.Conclusion The rebleeding rate in shunt group dominated by TIPS is lower,while the effect of long-term maintenance of liver function is better in vascular emboliza

关 键 词：肝硬化 门静脉高压症 消化道出血 经颈静脉肝内门体静脉分流术 脾动脉栓塞 

分 类 号：R575.21[医药卫生—消化系统]