胃冠状静脉栓塞术联合经颈静脉肝内门体分流术对肝硬化上消化道出血的疗效  

Efficacy of gastric coronary vein embolization combined with transjugular intrahepatic portosystemic stent-shunt in upper gastrointestinal hemorrhage of patients with cirrhosis

作　　者：唐丽江 李艳 孙玉欣 赵茗 Tang Lijiang;Li Yan;Sun Yuxin;Zhao Ming(Department of General Surgery,the Fifth People's Hospital of Qingdao(Shandong Qingdao Integrated Traditional Chinese and Western Medicine Hospital),Qingdao 266000,Shandong,China;Department of Medical Gastroenterology,the Fifth People's Hospital of Qingdao(Shandong Qingdao Integrated Traditional Chinese and Western Medicine Hospital),Qingdao 266000,Shandong,China)

机构地区：[1]青岛市第五人民医院(山东青岛中西医结合医院)普通外科,山东青岛266000 [2]青岛市第五人民医院(山东青岛中西医结合医院)消化内科,山东青岛266000

出　　处：《血管与腔内血管外科杂志》2023年第7期850-854,共5页Journal of Vascular and Endovascular Surgery

基　　金：青岛市中医科研计划课题[青卫中医字〔2015〕6号-19]。

摘　　要：目的探讨胃冠状静脉栓塞术(GCVE)联合经颈静脉肝内门体分流术(TIPS)对肝硬化上消化道出血的疗效和安全性。方法收集2019年12月至2022年10月于青岛市第五人民医院(山东青岛中西医结合医院)住院接受治疗的176例肝硬化上消化道出血患者的临床资料,根据治疗策略的不同将患者分为TIPS组(n=92,单独采取TIPS治疗)和联合组(n=84,采取GCVE联合TIPS)。主要终点是术后3个月的全因死亡率,次要终点是不同时间(术前、术后住院期间)的门静脉相关指标(门静脉内径、门静脉主干压力)、肝功能指标(谷丙转氨酶、总胆红素)、凝血功能指标(血小板计数、凝血酶原时间、活化部分凝血活酶时间)、术后住院期间再出血率、出院后3个月内再出血率及术后3个月内并发症的发生率。结果术后住院期间复查结果显示,两组患者的门静脉内径和门静脉主干压力均较本组术前降低,差异均有统计学意义(P﹤0.05);两组患者的肝功能指标、凝血功能指标比较,差异均无统计学意义(P﹥0.05)。术前、术后,两组患者的门静脉内径、门静脉主干压力、谷丙转氨酶水平、总胆红素水平、血小板计数、肝功能、凝血酶原时间、活化部分凝血活酶时间比较,差异均无统计学意义(P﹥0.05)。术后3个月内,联合组患者的全因死亡率低于TIPS组患者,差异有统计学意义(P=0.043)。术后住院期间,两组患者的再出血率比较,差异无统计学意义(P﹥0.05),但联合组患者出院后3个月内的再出血率低于TIPS组患者,差异有统计学意义(P=0.014)。联合组患者术后3个月内的并发症发生率高于TIPS组患者,差异有统计学意义(P=0.023)。结论GCVE联合TIPS可有效降低肝硬化上消化道出血患者的门静脉压力,从而达到止血的目的,同时可降低术后短期病死率,具有较好的安全性,值得临床推广。Objective To explore the efficacy and safety of gastric coronary vein embolization(GCVE)combined with trans-jugular intrahepatic portosystemic stent-shunt(TIPS)in the treatment of upper gastrointestinal hemorrhage of patients with cirrhosis.Method The clinical data of 176 patients with upper gastrointestinal hemorrhage due to cirrhosis who were hospitalized in the the Fifth People's Hospital of Qingdao(Shandong Qingdao Integrated Traditional Chinese and Western Medicine Hospital)from December 2019 to October 2022 were collected,according to the treatment strategy,the patients were divided into the TIPS group(n=92,treated with TIPS alone)and combined group(n=84,treated with GCVE combined with TIPS).The primary endpoint was all-cause mortality at 3 months after surgery,while the secondary endpoints were portal vein-related indicators(internal diameter of portal vein,pressure of portal venous trunk),liver function indicators(alanine aminotransferase,total bilirubin),and coagulation function indicators(platelet count,prothrombin time,activated partial thromboplastin time)at different times(preoperative and postoperative hospitalization),the rate of rebleeding during postoperative hospitalization,the rate of rebleeding within 3 months after discharge,and the incidence rate of complications within 3 months after surgery.Result The results of postoperative hospitalization reexamination showed that the the internal diameter of portal vein and pressure of portal venous trunk of the two groups of patients decreased compared to before surgery,and the differences were statistically significant(P<0.05);there was no statistically significant difference in liver function indicators and coagulation function indicators between the two groups of patients(P>0.05).Before and after surgery,there were no statistically significant difference in internal diameter of portal vein,pressure of portal venous trunk,alanine aminotransferase,total bilirubin,platelet count,liver function,prothrombin time and activated partial thromboplastin time

关 键 词：胃冠状静脉栓塞术 经颈静脉肝内门体分流术 肝硬化 上消化道出血 疗效 

分 类 号：R543[医药卫生—心血管疾病]