经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗乙型肝炎肝硬化并发食管胃静脉曲张患者效果分析  

Prevention of varices re-bleeding in patients with liver cirrhosis undergoing transjugular intrahepatic portosystemie stent and gastric coronary vein embolization

作　　者：孙静 张伟伟 马智勇 代树本 邓彦东[2] Sun Jing;Zhang Weiwei;Ma Zhiyong(Functional Department,Third People’s Hospital,Cangzhou 061001,Hebei Province,China)

机构地区：[1]河北省沧州市第三医院功能科,061001 [2]河北医科大学第一医院超声科

出　　处：《实用肝脏病杂志》2022年第6期853-856,共4页Journal of Practical Hepatology

基　　金：沧州市重点研发计划指导项目(编号:204106013)。

摘　　要：目的探讨经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)治疗肝硬化并发食管胃静脉曲张(EV)患者的效果。方法2018年1月~2020年12月我院收治的乙型肝炎肝硬化并发EV患者62例,其中33例(A组)接受TIPS联合GCVE治疗,29例接受TIPS联合食管静脉曲张套扎术(EVL)治疗,随访12个月。使用超声检测门静脉血流速度(PVFV)、门静脉压力(PVP)和门静脉压力梯度(PPG)。结果在术后1个月,A组PVFV为(15.9±1.8)cm/s,显著快于B组【(14.1±1.9)cm/s,P<0.05】,PVP和PPG分别为(20.3±2.7)mmHg和(9.7±1.2)mmHg,显著低于B组【分别为(22.8±2.9)mmHg和(11.4±0.9)mmHg,P<0.05】;在术后12个月,A组曲张静脉再出血发生率为6.0%,显著低于B组的31.0%(P<0.05),而分流道畅通和肝性脑病发生率分别为93.9%和9.1%,与B组的93.1%和6.9%比,无统计学差异(P>0.05);A组病死率为15.1%,显著低于B组的41.3%(P<0.05)。结论采用TIPS联合GCVE治疗肝硬化并发EV患者疗效确切,可有效提高门静脉血流速度,降低EV再出血发生率,提高生存率。Objective The aim of this study was to observe the efficacy of transjugular intrahepatic portosystemie stent(TIPS)and gastric coronary vein embolization(GCVE)in treatment of patients with liver cirrhosis and esophageal varices(EV).Methods 62 patients with decompensated cirrhosis were encountered in our hospital between January 2018 and December 2020,and 33 patients in group A underwent TIPS and GCVE and 29 patients in group B underwent TIPS and endoscopic esophageal varices ligation(EVL).The portal vein blood flow velocity(PVFV),portal venous pressure(PVP)and portal vein pressure gradient(PPG)were detected by ultrasonography.Results At the end of one month after surgery,the PVFV in group A was(15.9±1.8)cm/s,significantly more rapid than[(14.1±1.9)cm/s,P<0.05]in group B,while the PVP and PPG were(20.3±2.7)mmHg and(9.7±1.2)mmHg,significantly lower than[(22.8±2.9)mmHg and(11.4±0.9)mmHg,respectively,P<0.05]in group B;at the end of twelve month,the incidence of EV re-bleeding in group A was 6.0%,significantly lower than 31.0%(P<0.05)in group B,while there were no significant differences as respect to incidences of shunt patency and hepatic encephalopathy(93.9%and 9.1%vs.93.1%and 6.9%,P>0.05)between the two groups;the fatality in group A was 15.1%,significantly lower than 41.3%(P<0.05)in group B.Conclusion The efficacy of TIPS and GCVE in dealing with patients with liver cirrhosis and EV is efficacious,which might accelerate the blood flow velocity of portal vein,reduce re-bleeding and improve survivals.

关 键 词：肝硬化 食管胃静脉曲张 经颈静脉肝内门体分流术 胃冠状静脉栓塞术 治疗 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]