经颈静脉肝内门腔静脉分流术与经皮肝穿刺胃冠状静脉栓塞术治疗肝硬化食管胃底静脉曲张破裂出血疗效对比研究  

Comparative study of TIPS and PTVE in treatment of esophageal and gastric varices bleeding in liver cirrhosis

作　　者：刘杰[1] 闵林玲 潘金[1] 母燕玲 姚勇[1] LIU Jie;MIN Linling;PAN Jin;MU Yanling;YAO Yong(Department of Gastroenterology,Suining Central Hospital,Suining 629000,China)

机构地区：[1]遂宁市中心医院消化内科,四川遂宁629000 [2]遂宁市中心医院急症科,四川遂宁629000

出　　处：《陕西医学杂志》2023年第9期1191-1195,共5页Shaanxi Medical Journal

基　　金：四川省医学科研课题(S18014)。

摘　　要：目的:比较经颈静脉肝内门腔静脉分流手术(TIPS)与经皮肝穿刺胃冠状静脉栓塞术(PTVE)治疗肝硬化食管胃底静脉曲张破裂出血(EGVB)的疗效。方法:选取肝硬化EGVB患者135例,将采用TIPS治疗的患者纳入TIPS组(93例),将采用PTVE治疗的患者纳入PTVE组(42例)。于术前和术后1个月,比较两组患者食管胃底静脉曲张程度,外周血白细胞(WBC)、红细胞(RBC)和血小板(PLT),门脉系统血流动力学指标[门静脉直径(PVD)、门静脉流速(PVV)和脾静脉流速(SVV)]以及肝功能指标[血清谷草转氨酶(AST)、总胆红素(TBIL)和白蛋白(ALB)]。比较两组患者术后1个月并发症发生情况。结果:术前,两组患者食管胃底静脉曲张程度,外周血WBC、RBC和PLT,PVD、PVV和SVV,以及AST、TBIL和ALB比较,差异无统计学意义(均P>0.05)。术后1个月,两组食管胃底静脉曲张程度较术前改善,且TIPS组患者食管胃底静脉曲张程度较PTVE组减轻(均P<0.05);两组患者WBC和PLT水平较术前升高,且TIPS组高于PTVE组(均P<0.05);两组患者RBC比较差异无统计学意义(均P>0.05);两组患者PVD较术前降低,PVV和SVV较术前升高,且TIPS组PVD低于PTVE组,PVV和SVV高于PTVE组(均P<0.05);两组患者肝功能指标比较差异无统计学意义(均P>0.05);TIPS组并发症总发生率低于PTVE组(P<0.05)。结论:肝硬化EGVB患者采用TIPS进行治疗,可有效减轻食管胃底静脉曲张程度,降低门静脉压力,提高患者外周血WBC和PLT,改善门脉系统血流动力学,且对患者肝功能影响较小,安全性较高。Objective:To compare the efficacy of transjugular intrahepatic portosystemic shunt(TIPS)and percutaneous transhepatic varicral embolization(PTVE)in the treatment of esophageal and gastric varices bleeding(EGVB).Methods:A total of 135 patients with liver cirrhosis-induced EGVB were selected.Patients treated with TIPS were included in the TIPS group(93 cases),and patients treated with PTVE were included in the PTVE group(42 cases).Before operation and 1 month after operation,the severity of esophageal and gastric varices,peripheral blood WBC,RBC and PLT,Hemodynamic parameters of the portal vein system(portal vein diameter[PVD],portal vein flow velocity[PVV]and splenic vein flow velocity[SVV]),liver function parameters(serum aspartate aminotransferase[AST],total bilirubin[TBIL]and albumin[ALB])were compared between the two groups.The incidence of complications 1 month after operation was compared between the two groups.Results:There were no significant differences in the severity of esophageal and gastric varices,peripheral blood WBC,RBC and PLT,PVD,PVV and SVV,AST,TBIL and ALB between the two groups before operation(all P>0.05).One month after operation,the severity of esophageal and gastric varices in the two groups was improved compared with that before operation,and the severity of esophageal and gastric varices in the TIPS group was lighter than that in the PTVE group(all P<0.05);WBC and PLT levels in the two groups were higher than those before operation,and those in the TIPS group were higher than those in the PTVE group(all P<0.05),but there was no statistically significant difference in RBC between the two groups(P>0.05);PVD was lower than that before operation,PVV and SVV were higher than those before operation in the two groups,and PVD in the TIPS group was lower than that in the PTVE group,PVV and SVV in the TIPS group were higher than those in the PTVE group(all P<0.05);there were no statistically significant differences in liver function indexes between the two groups(all P>0.05).The total incidence of

关 键 词：肝硬化 食管胃底静脉曲张破裂出血 经颈静脉肝内门腔静脉分流术 经皮肝穿刺胃冠状静脉栓塞术 门脉系统 血流动力学 肝功能 

分 类 号：R543.6[医药卫生—心血管疾病]