TIPS联合PTVE治疗自身免疫性肝硬化曲张静脉出血疗效分析  

Transjugular intrahepatic portosystemic stent shunt combined with percutaneous transhepatic variceal embolization for variceal bleeding in liver cirrhosis caused by autoimmune liver diseases

作　　者：吴军政 刘圣[1] 施海彬[1] 杨魏 田伟[1] 周海峰 周卫忠[1] WU Junzheng;LIU Sheng;SHI Haibin;YANG Wei;Tian Wei;ZHOU Haifeng;ZHOU Weizhong(Department of Interventional Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2022年第8期1142-1146,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金项目(81701802)。

摘　　要：目的:探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic stent shunt,TIPS)联合曲张静脉栓塞(percutaneous transhepatic variceal embolization,PTVE)治疗自身免疫性肝病(autoimmune liver diseases,AILD)后肝硬化患者食管胃底曲张静脉破裂出血的安全性和有效性。方法:回顾性分析2015年8月—2021年9月南京医科大学第一附属医院收治的23例AILD后肝硬化合并食管胃底曲张静脉破裂出血患者(男2例,女21例)的临床资料。所有患者在保守治疗和/或内镜治疗失败后均接受了TIPS联合PTVE治疗。评估患者的即刻出血控制率、再出血率、无再出血生存期、总生存期和并发症。结果:患者即刻出血控制率为100%。1年、2年和3年的累计再出血率分别为9.6%、17.1%和17.1%。无出血生存时间70~1308 d,中位时间455 d。1年、2年、3年的累计生存率分别为100.0%、91.7%和91.7%。生存时间85~1308 d,中位时间611 d。严重的短期并发症包括急性心功能不全1例,腹腔出血1例。长期并发症包括4例脑性脑病,1例为West HavenⅢ级,另3例为West HavenⅡ级。结论:TIPS联合PTVE治疗AILD后肝硬化患者的食管胃底曲张静脉破裂出血可能安全有效。Objective:This study aims to investigate the safety and efficacy of transjugular intrahepatic portosystemic stent shunt(TIPS)combined with percutaneous transhepatic variceal embolization(PTVE)in the treatment of esophagogastric variceal bleeding in liver cirrhosis caused by autoimmune liver diseases(AILD).Methods:From August 2015 to September 2021,the clinical data of 23patients(2 males and 21 females)with esophagogastric variceal bleeding in liver cirrhosis caused by AILD were retrospectively analyzed.All patients received TIPS and PTVE treatment after conservative and/or endoscopic treatment failed to control bleeding.The immediate bleeding control rate,rebleeding rate,rebleeding-free survival,overall survival and complications were evaluated.Results:Patients showed a high immediate bleeding control rate(100%).The 1-,2-,and 3-year rebleeding rate were 9.6%,17.1%,and 17.1%,respectively.The median rebleeding-free survival time was 455 days(range:70-1308 days).The 1-,2-,3-year survival rate was 100%,91.7%,and 91.7%,respectively.The median overall survival time was 611 days(range:85-1308 days).The severe short-term complications included acute cardiac insufficiency(1 case)and intra-abdominal hemorrhage(1 case).Long-term complications were hepatic encephalopathy(4 cases),with West Haven gradeⅢin 1 case and West Haven GradeⅡin other 3 cases.Conclusion:TIPS combined with PTVE may be safe and effective in the management of esophagogastric variceal bleedingin liver cirrhosis caused by AILD.

关 键 词：经颈静脉肝内门体分流术 自身免疫性肝病 食管胃底静脉曲张出血 

分 类 号：R3815[医药卫生—医学寄生虫学]