EVL与早期行TIPS治疗肝硬化并发急性食管静脉曲张破裂出血的临床疗效及预后分析  

Clinical efficacy and prognosis analysis of EVL and early TIPS in treatment of acute esophageal variceal bleeding complicated by liver cirrhosis

作　　者：吴欣遥 赵芷藜 龙晓奇 舒梅玲 WU Xinyao;ZHAO Zhili;LONG Xiaoqi;SHU Meiling(Digestive Endoscopy Room,Digestive Center,Suining Central Hospital,Suining 629000,China)

机构地区：[1]遂宁市中心医院消化中心消化内镜室,629000

出　　处：《国际消化病杂志》2023年第4期263-268,共6页International Journal of Digestive Diseases

基　　金：四川省科技计划项目(2018JY0665)。

摘　　要：目的比较食管曲张静脉套扎术(EVL)和经颈静脉肝内门体分流术(TIPS)治疗肝硬化并发食管静脉曲张破裂出血(EVB)患者的临床疗效、预后及术后并发症情况。方法选择2019年3月至2021年3月遂宁市中心医院收治的102例因肝硬化并发EVB首次接受EVL或TIPS治疗的患者,分为EVL组(50例)和TIPS组(52例)。比较2组的止血成功率、食管胃静脉曲张(GOV)好转率、并发症发生情况、肝功能指标[TBil、ALT、白蛋白(ALB)]及外周血象指标[凝血酶原活动度(PTA)、国际标准化比率(INR)、血红蛋白(Hb)、血小板计数(PLT)]及预后情况(再出血率、死亡率)。结果TIPS组和EVL组的72 h止血成功率分别为98.08%和96.00%,2组的差异无统计学意义(P>0.05)。2组的术后第7天GOV均较术前显著好转(P均<0.05),并且TIPS组的GOV好转率显著高于EVL组(73.08%比46.00%,P<0.05)。TIPS组的术后并发症总发生率显著低于EVL组(7.69%比22.00%,P<0.05)。2组的术后第7天TBil、ALT水平均显著低于术前,ALB水平均显著高于术前(P均<0.05);2组间上述指标水平的差异均无统计学意义(P>0.05)。2组的术后第7天PTA均显著低于术前,Hb、INR、PLT均显著高于术前(P均<0.05);组间比较结果显示,术后第7天TIPS组的Hb显著高于EVL组(P<0.05),而2组的PTA、INR及PLT差异则均无统计学意义(P均>0.05)。术后随访结果显示,TIPS组的再出血率显著低于EVL组(21.15%比40.00%,P<0.05),2组的死亡率差异无统计学意义(P>0.05)。结论EVL和早期行TIPS治疗肝硬化并发EVB患者的72 h止血效果均较好,而早期行TIPS在改善GOV及预防再出血方面的效果更好,且并发症发生较少。Objective This paper intends to compare the clinical efficacy,prognosis,and postoperative complications of esophageal variceal ligation(EVL)and transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of patients with liver cirrhosis complicated by esophageal variceal vein rupture and bleeding(EVB).Methods From March 2019 to March 2021,one hundred and two patients with EVB due to cirrhosis who received EVL or TIPS treatment for the first time in Suining Central Hospital were selected and divided into the EVL group(50 cases)and the TIPS group(52 cases).The success rate of hemostasis,improvement rate of esophageal and gastric varices(GOV),incidence of complications,liver function indicators(TBil,ALT,albumin(ALB)),and peripheral blood count indicators(prothrombin activity(PTA),international standardized ratio(INR),hemoglobin(Hb),blood platelet count(PLT))and prognosis(rebleeding rate,mortality rate)were compared between the two groups.Results The 72 h hemostasis success rates of the TIPS group and the EVL group are 98.08% and 96.00%,respectively,with no statistically significant difference between the two groups(P>0.05).On the 7th day after surgery,both groups show significant improvement in GOV compared to before surgery(P<0.05),and the improvement rate of GOV in the TIPS group is significantly higher than that in the EVL group(73.08% versus 46.00%,P<0.05).The total incidence of postoperative complications in the TIPS group is significantly lower than that in the EVL group(7.69% versus 22.00%,P<0.05).On the 7th day after surgery,the levels of TBil and ALT in both groups are significantly lower than those before surgery,while the levels of ALB are significantly higher than those before surgery(P<0.05).There is no statistically significant difference in the levels of the above indicators between the two groups(P>0.05).On the 7th day after surgery,the PTA in both groups is significantly lower than that before surgery,while Hb,INR,and PLT are significantly higher than those before surgery(P<0.05).The results

关 键 词：食管静脉曲张套扎术 经颈静脉肝内门体分流术 肝硬化 食管静脉曲张 

分 类 号：R575.2[医药卫生—消化系统]