早期经颈静脉肝内门体分流术治疗老年肝硬化食管静脉曲张破裂出血的临床研究

目的探讨早期经颈静脉肝内门体分流术(early transjugular intrahepatic portosystemic shunt,TIPS)治疗老年肝硬化食管胃静脉曲张破裂出血(esophagogastric variceal bleeding,EVB)的临床疗效。方法回顾性分析2016年3月至2019年7月西部战区总医院282例老年肝硬化食管静脉曲张破裂急性出血患者的临床资料,采用倾向性匹配评分(propensity score matching,PSM)进行1∶1匹配,最终分为早期TIPS组(治疗组)及内镜下套扎组(对照组)各60例纳入研究;Kaplan-Meier曲线计算两组累计再出血率、累计生存率、累计肝性脑病发生率,组间率比较采用对数秩检验。结果治疗组与对照组术后12、24个月累计再出血率分别为3.7%vs 28.8%、10.4%vs 45.2%,治疗组明显低于对照组(P<0.05);两组术后3、6、12、24个月累计肝性脑病发生率分别为11.7%vs 5.0%、16.8%vs 12.0%、26.7%vs 18.0%、33.7%vs 20.5%,差异无统计学意义(P>0.05);两组术后12、24个月累计生存率分别为84.7%vs 76.7%、72.8%vs 55.8%,治疗组高于对照组(P<0.05);治疗组术后3个月静脉曲张治疗有效率为88.3%,高于对照组的70.0%(P<0.05)。结论早期TIPS是治疗部分老年肝硬化食管静脉曲张破裂急性出血的安全有效方法,与内镜下套扎治疗相比在降低再出血率,提高生存率、食管静脉曲张治疗有效率方面有突出的优势,并且肝性脑病的发生率没有明显升高。

Clinical study of early TIPS in the treatment of esophageal variceal bleeding in senile cirrhosis

Objective To discuss the clinical effect of early transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of esophagogastric variceal bleeding(EVB)in senile cirrhosis.Methods A retrospective analysis was performed on the clinical data of 282 senile cirrhosis who are acute esophageal variceal bleeding in our hospital from March 2016 to July 2019.Finally the patients were divided into early TIPS group(treatment group)and endoscopic ligation group(control group)with 60 cases each by using 1∶1 matching propensity score matching(PSM).K-M curve was used to calculate the rebleeding rate,survival rate and the incidence of hepatic encephalopathy,log rank test was used to compare the difference of the two groups.Results The cumulative rebleeding rates of treatment group and control group were 3.7%vs 28.8%、10.4%vs 45.2%in 12 months and 24 months after surgery respectively,The treatment group was significantly lower than the control group(P<0.05).The cumulative incidence of hepatic encephalopathy of treatment group and control group were 11.7%vs 5.0%、16.8%vs 12.0%、26.7%vs 18.0%、33.7%vs 20.5%in 3、6、12、24 months respectively(P>0.05),There is no significant difference in the incidence of hepatic encephalopathy between the two groups.The cumulative survival rates of treatment group and control group were 84.7%vs 76.7%、72.8%vs 55.8%in 12 and 24 months after operation,the treatment group is higher than the control group(P<0.05).The effective rate of varicose veins in the two groups was 88.3%vs 70.0%in 3 months after operation,and the treatment group was higher than the control group(P<0.05).Conclusion Early TIPS is a safe and effective method for the treatment of acute esophageal variceal bleeding in some elderly patients with liver cirrhosis.Compared with endoscopic ligation,it has outstanding advantages in reducing the rate of rebleeding,improving the survival rate and the effective rate of esophageal varices,and the incidence of hepatic encephalopathy is not significantly increased.