经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗门脉高压性上消化道出血的疗效及安全性评价  

Efficacy and safety evaluation of transjugular intrahepatic portosystemic shunt combined with gastric coronary vein embolization in the treatment of portal hypertensive upper gastrointestinal hemorrhage

作　　者：雷振东 顾福嘉[2] 彭孝春 LEI Zhendong;GU Fujia;PENG Xiaochun(Department of Interventional,General Hospital of Panjiang Investment Co.,Ltd.,Liupanshui,Guizhou,553536,China;Department of Interventional,Guizhou Provincial People's Hospital,Guiyang,Guizhou,550000,China)

机构地区：[1]盘江市投资有限公司总医院介入科,贵州六盘水553536 [2]贵州省人民医院介入科,贵州贵阳550000

出　　处：《当代医学》2023年第23期51-54,共4页Contemporary Medicine

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)治疗门脉高压性上消化道出血(UGH)患者的疗效及安全性。方法选取2018年1月至2021年1月本院收治的86例门脉高压性UGH患者作为研究对象,按照手术方式不同分为对照组与观察组,各43例。对照组行TIPS,观察组行TIPS联合GCVE。比较两组门脉血流动力学、肝功能、并发症发生情况及随访情况。结果术前、术后1个月,两组门脉主干压力、门脉内径、门脉流速、丙氨酸转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)水平比较差异无统计学意义;术后1个月,两组门脉主干压力、ALT、AST、TBIL水平均低于术前,门脉内径短于术前,门脉流速快于术前,差异有统计学意义(P<0.05);两组并发症发生率比较差异无统计学意义;观察组术后3个月内再出血率低于对照组,差异有统计学意义(P<0.05)。结论TIPS与TIPS联合GCVE均能改善门脉高压性UGH患者的门脉血流动力学与肝功能,但TIPS联合GCVE术后再出血发生率更低,且安全性高。Objective To investigate the effect of transjugular intrahepatic portosystemic shunt(TIPS)combined with gastric coronary vein embolization(GCVE)in the treatment of portal hypertensive upper gastrointestinal hemorrhage(UGH).Methods 86 patients with portal hypertension UGH admitted to our hospital from January 2018 to January 2021 were selected as the research subjects,and they were divided into the control group and the observation group according to different surgical methods,with 43 cases in each group.The control group received TIPS,and the observation group received TIPS combined with GCVE,the portal hemodynamics,liver function,complications,and follow-up were compared between the two groups.Results Before operation and 1 month after operation,there were no differences in main portal vein pressure,portal diameter,portal flow rate,alanine aminotransferase(ALT),aspartate aminotransferase(AST),and total bilirubin(TBIL)between the two groups;1 month after operation,the main portal vein pressure,ALT,AST,TBIL levels of the two groups were lower than before operation,portal vein diameter was shorter than before operation,and the portal flow velocity was faster than before operation,the differences were statistically significant(P<0.05);there were no differences of the incidence of complications between the two groups;the rate of rebleeding within 3 months after operation in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion TIPS and TIPS combined with GCVE can improve portal hemodynamics and liver function in patients with portal hypertension UGH,but the incidence of rebleeding after TIPS combined with GCVE is lower and does not increase the incidence of complications,and with high safety.

关 键 词：门脉高压性上消化道出血 经颈静脉肝内门体分流术 肝功能 并发症 

分 类 号：R573.2[医药卫生—消化系统]