超72h早期TIPS在肝硬化消化道出血中的临床应用  

Clinical application of early TIPS in patients with cirrhotic gastrointestinal bleeding over 72 hours

作　　者：王朝阳 周晨 刘家成 熊斌[1] WANG Chaoyang;ZHOU Chen;LIU Jiacheng;XIONG Bin(Department of Radiology,Afiliated Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei Province 430000,China)

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,湖北武汉430000

出　　处：《介入放射学杂志》2023年第9期909-913,共5页Journal of Interventional Radiology

基　　金：国家自然科学基金(81873917)。

摘　　要：目的探讨超72 h的早期经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)能否改善肝硬化消化道出血患者的预后。方法回顾性分析2016年8月至2021年12月期间于我院介入科行早期TIPS(出血后5 d内手术)治疗的62例肝硬化消化道出血患者,其中肝功能Child-Pugh C级患者10例,Child-Pugh B级合并内镜下活动性出血患者52例。根据TIPS是否在患者出血后72 h内完成,患者被分为超72 h组(n=25)和72 h以内组(n=37)。随访观察两组患者预后,包括生存情况、消化道再出血率及肝性脑病发生率。结果所有患者均成功手术,超72 h组患者门静脉压力梯度(portal pressure gradient,PPG)由分流前(25.91±4.26)mmHg降低至分流后(10.35±2.68)mmHg,72 h以内组由(26.93±3.67)mmHg降低至(10.94±2.49)mmHg,两组患者分流前后PPG均无统计学差异(P=0.342;P=0.402)。患者中位随访时间为28个月(四分位距12~37个月),随访过程中,两组患者累积死亡率(16%vs13.5%,Log-rank P=0.813)、再出血率(12%vs 8.1%,Log-rank P=0.582)及肝性脑病发生率(24%vs 29.7%,Log-rank P=0.648)均无统计学差异。结论超72 h早期TIPS仍可降低肝硬化消化道出血患者再出血及死亡风险,其预后与72 h内行TIPS无显著差异。Objective To clarify whether early transjugular intrahepatic portosystemic shunt(TIPS performed over 72 hours after the onset of gastrointestinal bleeding can improve the prognosis of patients with cirrhosis.Methods The clinical data of a total of 62 patients with cirrhotic gastrointestinal bleeding,who were admitted to the Intervention Department of the Affiliated Union Hospital,Tongji Medical College of Huazhong University of Science and Technology of China between August 2016 and December 2021 to receive early TIPS treatment(within 5 days after the onset of bleeding),were retrospectively analyzed.Of the62 patients,liver function of Child-Pugh grade C was seen in 10,and Child-Pugh grade B together with endoscopic active bleeding was seen in 52.According to whether TIPS procedure was accomplished within 72hours after the onset of bleeding,the patients were divided into over-72 h group(n=25)and within-72 h group(n=37).The prognosis,survival,gastrointestinal rebleeding rate,and the incidence of hepatic encephalopathy(HE)were compared between the two groups.Results Successful TIPS was accomplished in all the 62 patients.The portal pressure gradient(PPG)in the over-72 h group(n=25)dropped from preoperative(25.91±4.26)mmHg to postoperative(10.35±2.68)mmHg,which in the within-72 h group dropped from preoperative(26.93±3.67)mmHg to postoperative(10.94±2.49)mmHg,the differences in the preoperative and postoperative PPG between the two groups were not statistically significant(P=0.342 and P=0.402,respectively).The median follow-up period was 28 months(quartile of 12-37 months).During the follow-up period,in the over-72 h group and the within-72 h group the cumulative mortality was 16%and 13.5%respectively(Log-rank P=0.813),the gastrointestinal rebleeding rate was 12%and 8.1%respectively(Log-rank P=0.582),and the incidence of HE was 24%and 29.7%respectively(Log-rank P=0.648),the differences in all the above indexes between the two groups were not statistically significant.Conclusion In patients with cirrhotic gastroin

关 键 词：经颈静脉肝内门体分流术 早期 肝硬化 消化道出血 

分 类 号：R575.2[医药卫生—消化系统]