经颈静脉肝内门体分流术后上消化道再出血的临床分析

目的探讨经颈静脉肝内门体分流术（TIPS）术后上消化道再出血的原因及发病机制。方法选择50例行TIPS患者，对其进行观察随访，分析各种因素在术后上消化道再出血中的作用。结果50例行TIPS患者门静脉压力由术前（39．8±9．2）cmH2O（1cmH2O=0．098kPa）降至术后（25．2±5．8）cmH2O，差异有统计学意义（P〈0．05）。14例患者术后出现上消化道再出血，发生率为28％（14／50），其中3例在术后3d内出现呕吐鲜血，考虑急性胃黏膜病变出血，经内科治疗后短期内出血均得到控制（其中1例患者在术后1年余再发上消化道出血）；12例患者在TIPS术后2年内出现上消化道再出血，出血原因：6例为食管胃底静脉曲张破裂再出血，3例为胃十二指肠溃疡，2例为糜烂性胃炎，1例与凝血异常有关。食管胃底静脉曲张破裂再出血发生率为12％（6／50）。结论TIPS术后并发上消化道再出血的原因主要分为静脉曲张性再出血和非静脉曲张性再出血二种，二者均是TIPS术后重要的再出血原因，静脉曲张性再出血多发生于术后3个月以上，而非静脉曲张性再出血多发生于术后3个月以内。因此对术后患者常规给予质子泵抑制剂保护胃黏膜十分重要。

The clinical analysis of upper gastrointestinal rehaemorrhagia after transjugular intrahepatic portasystemic shunt

Objective To study the pathogenesis of upper gastrointestinal rehaemorrhagia after the transjugular intrahepatic portasystemic shunt （TIPS） and its influencing factor. Methods Fifty postoperative patients with TIPS were selected. The patients were followed-up, and the effect of the various factors in the role of upper gastrointestinal rehaemorrhagia after TIPS was analyzed. Results The portal vein pressure of 50 patients with TIPS decreased from preoperative （39.8±9.2） cmH2O （1 cmH2O =0.098 kPa） to postoperative （25.2 ± 5.8） cmH2O, and there was statistical difference （P 〈 0.05 ）. Fourteen patients appeared upper gastrointestinal rehaemorrhagia after TIPS, which accounted for total of 28% （14/50） and included 3 cases of postoperative vomiting blood within 3 days. Acute stomach mucosa lesions bleeding was considered, and bleeding was controlled within a short-term medical treatment （ 1 patient after more than ayear in recurrent upper gastrointestinal rehaemorrhagia）. Twelve cases of patients appeared upper gastrointestinal rehaemorrhagia within 2 years after TIPS, and the causes of rehaemorrhagia in 6 cases were esophageal variceal rehaemorrhagia, gastric and duodenal ulcer in 3 cases,erosive gastritis in 2 cases, coagulation abnormalities in 1 case. Esophageal variceal rehaemorrhagia rate was 12% （6/50）. Conclusions The main reasons of upper gastrointestinal rehaemorrhagia after TIPS are variceal rehaemorrhagia and non variceal rehaemorrhagia,both of which are important causes of rehaemorrhagia after TIPS. Variceal rehaemorrhagia after TIPS occurs more than 3 months,and non variceal rehaemorrhagia occurs within 3 months, so it is very important to protect gastric mucosa with proton pump inhibitor in postoperative patients.