| 经颈静脉肝内门体分流术与内镜治疗预防食管胃底静脉曲张出血的效果 |
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| 作者姓名： | 姚勇 奉镭 高明生 张描 |
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| 作者单位： | 遂宁市中心医院消化内科，四川 遂宁 629000 |
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| 基金项目： | 四川省医学科研课题S18014 |
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| 摘 要： | 目的 分析经颈静脉肝内门体分流术（TIPS）与内镜治疗对食管胃底静脉曲张出血（EGVB）的预防效果，为肝硬化患者早期合理选择治疗方案提供参考依据。 方法 回顾性分析2018年1月~2020年2月于遂宁市中心医院接受一级预防的肝硬化合并食管胃底静脉曲张的89例患者，根据手术方式不同将患者分为两组，其中进行内镜下套扎治疗（EVL）者纳入EVL组（n=43），进行TIPS治疗者纳入TIPS组（n=46），比较两组静脉曲张改善效果，治疗前后门静脉内径、肝功能变化以及治疗后患者EGVB、并发症和死亡发生情况。结果TIPS组和EVL组静脉曲张改善有效率分别为90.70%和86.96%，差异无统计学意义（P > 0.05）；两组治疗后肝功能Child-Pugh分级及评分差异无统计学意义（P > 0.05），TIPS组术后门体循环压力差降低（P < 0.05），且治疗后3、6、12、24月时门静脉内径门静脉内径低于EVL组，差异有统计学意义（P < 0.05）；两组治疗后EGVB发生率分别为32.56%和17.39%（P > 0.05），其中TIPS组远期出血（治疗3月后）发生率低于EVL组，差异有统计学意义（P < 0.05）；两组术后并发症发生率、死亡率差异无统计学意义（P > 0.05）。 结论 早期TIPS和EVL用于肝硬化患者一级预防均可有效改食管胃底善静脉曲张，有利于降低EGVB发生风险，且TIPS在降低门静脉压力和远期出血发生率方面较EVL具有一定优势。
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| 关 键 词： | 食管胃底静脉曲张 经颈静脉肝内门体分流术 内镜治疗 预防出血 |
| 收稿时间： | 2022-04-08 |
Effects of transjugular intrahepatic portosystemic shunt and endoscopic therapy on the prevention of |
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| Authors: | YAO Yong FENG Lei GAO Mingsheng ZHANG Miao |
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| Affiliation: | Department of Gastroenterology, Suining Central Hospital, Suining 629000, China |
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| Abstract: | Objective To analyze the the preventive effects of transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic therapy on esophageal and gastric variceal bleeding (EGVB), and provide a reference for early rational treatment regimen for patients with liver cirrhosis. Methods Eighty-nine patients with liver cirrhosis complicated with EGVB who received primary prevention in Suining Central Hospital from January 2018 to February 2020 were selected. They were divided into two groups according to different surgical methods. Among the patients, the cases undergoing endoscopic variceal ligation were set as EVL group (n=43) and the cases receiving TIPS were included in TIPS group (n=46). The improvement effects of varicose veins, changes in portal vein diameter and liver function before and after treatment as well as occurrence of EGVB, complications and death after treatment were compared between the two groups. Results The effective rate of varicose veins improvement was 90.70% in TIPS group and 86.96% in EVL group (P > 0.05). The liver function Child-Pugh classification and score in the two groups showed no significant changes (P > 0.05). The portal-systemic pressure gradient in TIPS group after surgery was significantly reduced (P < 0.05). At 3, 6, 12, 24 months after treatment, the portal vein diameter in TIPS group was smaller than that in EVL group (P < 0.05). The incidence rates of EGVB in the two groups after treatment were 32.56% and 17.39% respectively (P > 0.05), and the incidence rate of long-term bleeding after 3 months of treatment was significantly lower in TIPS group than that in EVL group (P < 0.05). The incidence rates of postoperative complications and the death rates between 2 groups were not significantly differrent (P > 0.05). Conclusion Both early TIPS and EVL for primary prevention of patients with liver cirrhosis can effectively improve the esophageal and gastric varices and help to reduce the risk of EGVB. TIPS has certain advantages in reducing the portal venous pressure and incidence rate of long-term bleeding. |
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