经颈静脉肝内门体静脉分流术预防上消化道出血的临床研究  

Clinical study on prevention of upper gastrointestinal bleeding by transjugular intrahepatic portosystemic shunt

作　　者：吴广迎 张延娟 秦鹏[1] 卢艳丽 Wu Guangying;Zhang Yanjuan;Qin Peng;Lu Yanli(Department of Interventional Vascular Surgery,the Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,China;Department of Critical Care Medicine,the Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,China;Department of Emergency Medicine,the Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,China)

机构地区：[1]邢台医学高等专科学校第二附属医院介入血管外科,河北省054000 [2]邢台医学高等专科学校第二附属医院重症医学科,河北省054000 [3]邢台医学高等专科学校第二附属医院急诊医学科,河北省054000

出　　处：《中华消化病与影像杂志（电子版）》2024年第6期545-548,共4页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

基　　金：河北省邢台市重点研发计划自筹项目(2022ZC215)。

摘　　要：目的分析经颈静脉肝内门体静脉分流术(TIPS)预防上消化道出血的临床效果。方法选取邢台医学高等专科学校第二附属医院2021年2月至2023年2月收治的120例急性上消化道出血患者,随机分为套扎组(n=60)、TIPS组(n=60),2组分别接受内镜下曲张静脉套扎治疗和TIPS治疗。对比2组手术前后门脉压力梯度、血常规、血流量、肝功能变化,并对患者开展12个月随访,记录其累积再出血发生率。结果2组术后门静脉压力梯度均较术前下降;TIPS组术后门静脉压力梯度、门静脉血流量、脾静脉血流量均较套扎组更低(P<0.05)。术后3d,2组血小板、血红蛋白、红细胞计数均较术前升高(P<0.05),同时点组间血常规指标比较,差异无统计学意义(P>0.05);2组总胆红素、谷丙转氨酶、谷草转氨酶水平均较术前下降,TIPS组术后肝功能指标均较对照组更高(P<0.05)。套扎组术后12个月累积再出血发生率为21.67%,较TIPS组的8.33%更高(P<0.05)。结论TIPS与内镜下套扎均可达到良好的上消化道出血止血效果,TIPS在改善门静脉压力梯度和血流量、预防再出血方面效果更为显著,但对肝功能恢复存在一定影响。Objective To analyze the clinical effect of transjugular intrahepatic portosystemic shunt(TIPS)in preventing upper gastrointestinal bleeding.Methods A total of 120 patients with acute upper gastrointestinal bleeding admitted to the Second Affiliated Hospital of Xingtai Medical College from February 2021 to February 2023 were selected and randomly divided into ligation group(n=60)and TIPS group(n=60).The two groups were treated with endoscopic variceal ligation and TIPS respectively.The changes of portal pressure gradient,blood routine,blood flow and liver function were compared between the two groups before and after operation,and the patients were followed up for 12 months to record the incidence of cumulative rebleeding.Results The pressure gradient of portal vein decreased after operation in both groups.The portal vein pressure gradient,portal vein blood flow and splenic vein blood flow in TIPS group were lower than those in ligation group(P<0.05).Platelet,hemoglobin and red blood cell in the two groups were all higher than those before operation on the 3rd day after operation(P<0.05).At the same time,there was no statistical difference in blood routine indexes between the two groups(P>0.05).The levels of total bilirubin,alanine transaminase and aspartate transaminase in the two groups decreased on the 3rd day after operation,while those in the TIPS group were higher than those in the control group(P<0.05).The incidence of cumulative rebleeding in ligation group was 21.67%at 12 months after operation,which was higher than 8.33%in TIPS group(P<0.05).Conclusion Both TIPS and endoscopic ligation can achieve good hemostasis effect for upper gastrointestinal bleeding.TIPS is more effective in improving portal vein pressure gradient and blood flow and preventing rebleeding,but it has certain influence on the recovery of liver function.

关 键 词：上消化道出血 经颈静脉肝内门体静脉分流术 内镜下套扎 再出血 

分 类 号：R573.2[医药卫生—消化系统]