经颈静脉肝内门体分流术在肝硬化食管胃底静脉曲张破裂出血中的应用现状与未来展望

食管胃底静脉曲张破裂出血是肝硬化门静脉高压的致命性并发症。经颈静脉肝内门体分流术(TIPS)是治疗门静脉高压并发症的有效手段。TIPS可用于预防复发性或顽固性腹水患者的首次静脉曲张出血。对急性静脉曲张出血高危(Child-Pugh C级<14分、Child-Pugh B级>7分伴内镜下活动性出血或肝静脉压力梯>20 mmHg)的患者，应当尽早行TIPS治疗。对标准治疗失败的急性静脉曲张出血,TIPS是有效的挽救措施。此外,TIPS也是预防静脉曲张再出血的二线选择。     

经颈静脉肝内门体分流术在食管胃静脉曲张出血治疗中的进展

经颈静脉肝内门体分流术（TIPS）是食管胃静脉曲张出血重要的治疗措施,既往把它作为肝移植前的桥梁。随着覆膜支架的应用及早期TIPS概念的提出,其在临床中的应用越来越广泛。门静脉高压所致的食管胃静脉曲张出血和腹水是其主要的适应证,近10年来对其获益人群和最佳治疗时机进行了广泛研究。在急性出血中对于内镜不能控制的大出血、标准治疗后早期再出血、Child-Pugh C级（评分<14分）肝功能患者、Child-Pugh B（评分>7分）伴内镜下活动性出血者、严重门静脉高压（HVPG>20 mmHg）者,TIPS治疗可改善预后。TIPS对食管胃静脉曲张出血二级预防的最佳时机和适宜人群尚不明确。术前存在的肝性脑病、肝肾综合征、门静脉血栓、门静脉海绵样变性、肝脏肿瘤等不是行TIPS治疗的绝对禁忌证。     

双导丝一步穿刺法及经皮肝穿刺门静脉造影在TIPS中的应用

目的探讨双导丝一步穿刺法及经皮肝穿刺门静脉造影在TIPS中的操作方法及应用价值。方法采用双导丝一步穿刺法及经皮肝穿刺门静脉造影法,对21例肝硬化并食管胃底静脉曲张破裂出血患者行TIPS术。结果 21例患者均成功实施TIPS手术,手术时间(152.41±50.38)min,手术穿刺针数(2.50±1.54)针,结果显示改良TIPS术可显著降低门静脉压力,改善肝功能,手术成功率100%,病死率5%。结论采用双导丝一步穿刺法及经皮肝穿刺门静脉造影的方法行TIPS术,能降低手术难度,值得临床推广应用。     

经颈静脉肝内门体静脉分流术与曲张静脉栓塞术联合应用的临床研究

目的分析经颈静脉肝内门体静脉分流术(transjugular intrahepatic porto-systemic shunt,TIPS)与食管胃曲张静脉栓塞术联合应用治疗肝硬化门静脉高压合并食管胃静脉曲张破裂出血的临床疗效及安全性。方法对2009年10月—2012年10月临床收治的299例肝硬化门静脉高压合并食管胃静脉曲张破裂出血患者行TIPS与食管胃曲张静脉栓塞术联合治疗,测量患者栓塞前后和支架置入前后门静脉压力。观察和统计术后再出血率、分流道再狭窄率和肝性脑病发生率。结果完成TIPS与曲张静脉栓塞术联合手术297例,成功率为99.3%。297例均在术后随访3年,术后1、2、3年再出血率分别为4.7%、11.1%和19.2%;3年分流道累计狭窄率为19.5%。结论 TIPS与曲张静脉栓塞术联合应用是治疗门脉高压食管胃底静脉曲张破裂出血的最佳治疗方法,弥补了二种技术单独临床应用的不足,而且并不增加行TIPS的复杂性和风险。     

经颈静脉肝内门体分流术专家共识

<正>经颈静脉肝内门体分流术(TIPS)是指经颈静脉入路从肝静脉穿刺肝内门静脉,在肝静脉与门静脉之间建立门-体分流道,以达到降低门静脉压力、治疗食管胃静脉曲张破裂出血和顽固性腹腔积液等一系列门静脉高压并发症的微创介入治疗技术。自20世纪80年代末R9ssle等~([1])首次采用TIPS成功治疗1例门静脉高压静脉曲张出血伴大量腹腔积液患者以来,该技术广泛用于治疗门静脉高压并发症,适应证也逐步扩展~([2-3])。TIPS技术20世纪90年代初被引入中     

经颈静脉肝内门体分流术在肝硬化静脉曲张出血防治中的地位

静脉曲张出血是肝硬化门静脉高压常见的致死性并发症,大约50%的肝硬化患者在诊断为肝硬化时既已合并静脉曲张。自从1988年经颈静脉肝内门体分流术(TIPS)首次应用于临床以来,大量的临床研究不断的更新与完善了TIPS的相关知识。本文主要对TIPS在肝硬化门静脉高压静脉曲张出血的防治中的地位作一综述,包括TIPS在肝硬化门脉高压静脉曲张出血的初级预防、急性静脉曲张出血的治疗以及肝硬化静脉曲张再出血的预防中的应用。TIPS是肝硬化门静脉高压静脉曲张的有效疗法,随着技术的不断进步,将有越来越多的患者成为TIPS的适应证,TIPS在肝硬化门脉高压静脉曲张出血的防治中将发挥越来越重要的作用。     

经颈静脉肝内门体分流术作为静脉曲张出血二级预防的一线治疗方案能有效改善患者生存

正【据《J Gastroenterol Hepatol》2020年2月报道】题:将经颈静脉肝内门体分流术作为静脉曲张出血二级预防的一线治疗方案(作者Liu JC等)将经颈静脉肝内门体分流术(TIPS)作为门静脉压力梯度≥25 mm Hg的静脉曲张出血患者二级预防的一线治疗方案并与其作为二线治疗方案进行比较,评估其对于患者生存预后的影响。本回顾性研究纳入了50例确诊为肝硬化食管静脉曲张出血的患者,其中35例接受TIPS作为静脉曲张出血二级     

经颈静脉肝内门体分流术前后肝硬变患者门静脉血液动力学改变

目的:观察经颈静脉肝内门体分流术前后肝硬变患者门静脉血流动力学变化。方法:采用经颈静脉肝内门体分流术(TIPS)治疗8例肝硬变门静脉高压(CPH)食管静脉曲张出血患者,用彩色多普勒超声显像仪对治疗前后患者门静脉血流动力学改变进行研究。结果:经TIPS术后门静脉血流速度、血流量明显增高,由术前10.26±4.25cm/s、1145.36±436.52ml/min增高至术后一、三周的21.70±5.89cm/s、19.72±5.24cm/s和2238.79±971.4ml/min、2054.71±880.56ml/min,P<0.01、0.05。门静脉压力由3.6kPa和0.7kP9降至1.73kPa和0.35kPa,P<0.01。结论:肝硬变门静脉高压症患者TIPS术后进行彩色多普勒门静脉血液动力学测定,可以了解门静脉血液状态,对判断预后有一定价值。     

经颈静脉肝内门体分流术对脾切除术后门静脉血栓患者食管静脉曲张再出血的预防价值

目的探讨预防脾切除术后门静脉血栓(PVT)患者发生食管静脉曲张再出血,行经颈静脉肝内门体分流术(TIPS)的技术成功率和结局。方法回顾性分析2009年12月—2017年1月山东省立医院收治的因预防食管静脉曲张再出血行TIPS的46例脾切除术后PVT患者的临床资料。根据TIPS是否成功,将患者分为TIPS成功组(38例)和TIPS失败组(8例),分析两组患者术后曲张静脉再出血、支架功能障碍、肝性脑病(HE)及生存状况。计量资料两组间比较采用配对t检验,计数资料两组间比较采用χ~2检验。Kaplan-Meier曲线分析无曲张静脉再出血率、支架通畅率、无HE发生率和生存率。累积无再出血率和累积生存率比较采用log-rank检验。结果 TIPS成功率为82.6%。TIPS成功组与失败组6、12、24个月累积无再出血率分别为94.3%、89.8%、89.8%和85.7%、85.7%、28.6%,两组比较差异有统计学意义(χ~2=4.563,P=0.033)。TIPS成功组支架在6、12、24个月累积通畅率分别为79.3%、74.3%、69.0%,TIPS术后累积无HE发生率在6、12、24个月分别为72.1%、55.5%、55.5%。TIPS成功组与失败组6、12、24个月累积生存率分别为94.0%、94.0%、86.2%和71.4%、71.4%、71.4%,两组比较差异有统计学意义(χ~2=4.988,P=0.026)。结论 TIPS是预防脾切除术后PVT患者食管静脉曲张再出血的一种安全可行的方法。将TIPS与经皮经肝途径相结合可以促进技术成功。     

肝硬化食管胃底静脉曲张破裂出血的急诊TIPS术可行性

目的探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)用于急性肝硬化食管胃静脉曲张破裂出血的可行性。方法选择2011年9月至2013年9月收治的28例急性肝硬化食管胃静脉曲张破裂出血患者,均实施急诊TIPS术。结果 28例患者均1次操作成功接受TIPS术,术后24 h的止血率为100.0%。患者的平均门静脉压力术后较术前显著下降,分别为(27.01±5.32)和(38.23±7.41)cmH2O,门体循环压力差显著减小,分别为(18.76±4.70)和(30.45±7.69)cmH2O,经比较差异均有统计学意义(t=9.56,8.74,均P0.05)。术后,患者肝功能各项指标及凝血酶原时间较之术前均未出现显著改变,经比较差异均无统计学意义,(均P0.05)。术后随访3个月,所有患者支架均通畅,1例分流道为门静脉左支患者出现狭窄闭塞。1例患者出现肝性脑病,1例患者出现肝功能衰竭,经治疗无效死亡。结论急诊TIPS术用于急性肝硬化食管胃静脉曲张破裂出血可以获得良好的效果,安全性高。     

The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension

Transjugular intrahepatic portosystemic shunt (TIPS) is an interventional radiology technique that has shown a 90% success rate to decompress the portal circulation. As a non-surgical intervention, without requirement for anesthesia and very low procedure-related mortality, TIPS is applicable to severe cirrhotic patients, who are otherwise untreatable, for example, nonsurgical candidates. TIPS constitutes the most frequently employed tool to achieve portosystemic shunting. TIPS acts by lowering portal pressure, which is the main underlying pathophysiologic determinant of the major complications of cirrhosis. Regarding esophagogastric variceal bleeding, TIPS has excellent hemostatic effect (95%) with low rebleeding rate (<20%). TIPS is an accepted rescue therapy for first line treatment failures in 2 settings (1) acute variceal bleeding and (2) secondary prophylaxis. In addition, TIPS offers 70% to 90% hemostasis to patients presenting with recurrent active variceal bleeding. TIPS is more effective than standard therapy for patients with hepatic venous pressure gradient >20mm Hg. TIPS is particularly useful to treat bleeding from varices inaccessible to endoscopy. TIPS should not be applied for primary prophylaxis of variceal bleeding. Portosystemic encephalopathy and stent dysfunction are TIPS major drawbacks. The weakness of the TIPS procedure is the frequent need for endovascular reintervention to ensure stent patency. The circulatory effects of TIPS are an attractive approach for the treatment of refractory ascites and hepatorenal syndrome, yet TIPS is not considered first line therapy for refractory ascites owing to unacceptable incidence of portosystemic encephalopathy. Pre-TIPS evaluation taking into account predictors of outcome is mandatory. The improved results achieved with covered-stents might expand the currently accepted recommendations for TIPS use.     

Cost analysis for the prevention of variceal rebleeding: a comparison between transjugular intrahepatic portosystemic shunt and endoscopic sclerotherapy in a selected group of Italian cirrhotic patients

The aim of the present study was to compare the cumulative cost of the first 18-month period in a selected group of Italian cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic sclerotherapy (ES) to prevent variceal rebleeding. Thirty-eight patients enrolled in a controlled trial were considered (18 TIPS and 20 sclerotherapy). The number of days spent in the hospital for the initial treatment and during the follow-up period were defined as the costs of hospitalization. ES sessions, TIPS procedures, angioplasty or addition of a second stent to maintain the shunt patency, were defined as the costs of therapeutic procedures. The two groups were comparable for age, sex, and Child-Pugh score. During the observation period 4 patients died in the TIPS group, and 2 died and 1 was transplanted in the sclerotherapy group. The rebleeding rate was significantly higher in the sclerotherapy group. Despite this, the number of days spent in the hospital was similar in the two groups. This was because of a higher number of hospital admissions for the treatment of hepatic encephalopathy and shunt insufficiency in the TIPS group. The therapeutic procedures were more expensive for TIPS. Consequently, the cumulative cost was higher for patients treated with TIPS than for those treated with sclerotherapy. The extra cost was because of the initial higher cost of the procedure and the difference was still maintained at the end of the 18-month follow-up. When the cumulative costs were expressed per month free of rebleeding, the disadvantage of TIPS disappeared. In conclusion, a program of prevention of variceal rebleeding with TIPS, despite the longer interval free of rebleeding, is not a cost-saving strategy in comparison with sclerotherapy.     

Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt

AIM:To evaluate the effect of the shunting branch of the portal vein(PV)(left or right)and the initial stent position(optimal or suboptimal)of a transjugular intrahepatic portosystemic shunt(TIPS).METHODS:We retrospectively reviewed 307 consecu5tive cirrhotic patients who underwent TIPS placement for variceal bleeding from March 2001 to July 2010 at our center.The left PV was used in 221 patients and the right PV in the remaining 86 patients.And,224 and83 patients have optimal stent position and sub-optimal stent positions,respectively.The patients were followed until October 2011 or their death.Hepatic encephalopathy,shunt dysfunction,and survival were evaluated as outcomes.The difference between the groups was compared by Kaplan-Meier analysis.A Cox regression model was employed to evaluate the predictors.RESULTS:Among the patients who underwent TIPS to the left PV,the risk of hepatic encephalopathy(P=0.002)and mortality were lower(P<0.001)compared to those to the right PV.Patients who underwent TIPS with optimal initial stent position had a higher primary patency(P<0.001)and better survival(P=0.006)than those with suboptimal initial stent position.The shunting branch of the portal vein and the initial stent position were independent predictors of hepatic encephalopathy and shunt dysfunction after TIPS,respectively.And,both were independent predictors of survival.CONCLUSION:TIPS placed to the left portal vein with optimal stent position may reduce the risk of hepatic encephalopathy and improve the primary patency rates,thereby prolonging survival.     

Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial

BACKGROUND AND AIMS: The transjugular intrahepatic portosystemic shunt (TIPS) is a new therapeutic modality for variceal bleeding. In this study we compared the two year survival and rebleeding rates in cirrhotic patients treated by either variceal band ligation or TIPS for variceal bleeding. METHODS: Eighty cirrhotic patients (Pugh score 7-12) with variceal bleeding were randomly allocated to TIPS (n=41) or ligation (n=39), 24 hours after control of bleeding. RESULTS: Mean follow up was 581 days in the ligation group and 678 days in the TIPS group. The two year survival rate was 57% in the TIPS group and 56% in the ligation group (NS); the incidence of variceal rebleeding after two years was 18% in the TIPS group and 66% in the ligation group (p<0.001). Uncontrolled rebleeding occurred in 11 patients in the ligation group (eight were rescued by emergency TIPS) but in none of the TIPS group. The incidence of encephalopathy at two years was 47% in the TIPS group and 44% in the ligation group (NS). CONCLUSIONS: TIPS did not increase the two year survival rate compared with variceal band ligation after variceal bleeding in cirrhotic patients with moderate or severe liver failure. It significantly reduced the incidence of variceal rebleeding without increasing the rate of encephalopathy.     

Prognostic role of the initial portal pressure gradient reduction after TIPS in patients with cirrhosis

BACKGROUND: The aim of this study was to determine the prognostic relevance of the portal pressure gradient (PPG) before and after transjugular intrahepatic portosystemic stent shunt (TIPS) insertion in patients with liver cirrhosis and recurrent oesophageal variceal bleeding. METHODS: 118 cirrhotic patients (Child A/B/C, 41/56/21; Child score, 7.7+/-2.0; baseline PPG, 21.8+/-4.7 mmHg) underwent TIPS for the prevention of variceal rebleeding. A multivariate logistic regression analysis was applied to identify the independent determinants of rebleeding and survival. The estimated rebleeding rate and the estimated survival were compared by log-rank testing. RESULTS: TIPS insertion reduced the PPG by 53.2+/-17.7%. During follow-up 21 patients suffered significant rebleeding (17.8%); bleeding-related mortality was 3.4% (four patients). The median survival [95% confidence intervals (CI)] was 48.2 (39.8; 60.8) months. The multivariate Cox model identified creatinine as the only independent predictor of survival, and the initial decrease of the PPG after TIPS as the only independent predictor of rebleeding. PPG before TIPS (21.8+/-4.7 mmHg) and the gradient at the time of rebleeding (22.0+/-2.9 mmHg) did not differ significantly. Patients with an initial decrease of the PPG after TIPS <30% were at the highest risk for rebleeding. Patients with an initial decrease of the PPG >60% rarely suffered from rebleeding. CONCLUSIONS: The initial decrease in the PPG after TIPS is a predictor for the risk of rebleeding but not for survival after TIPS. For that reason, in patients undergoing TIPS placement for the prevention of recurrent bleeding from oesophageal varices, an initial reduction of the PPG of 30-50% should be attempted.     

介入性门腔分流术治疗门脉高压症所致曲张静脉出血及腹水疗效观察

目的 评价介入性门腔分流术治疗门脉高压症所致曲张静脉出血及腹水的疗效。方法 回顾性分析2004年2月—2010年1月我院55例良性门脉高压症行介入性门腔分流术患者的临床资料,观察分流道近期和远期的通畅情况,并分析生存时间和并发症。结果 手术成功率为100%,患者门静脉压力梯度(portal pressure gradient,PPG)均达到要求,即PPG≤1.60kPa或PPG降低2.00kPa。术后1～5年生存率分别为70.4%、60.8%、60.8%、60.8%、60.8%;分流道再狭窄率分别为7.3%、13.1%、24.0%、24.0%、24.0%;消化道曲张静脉出血复发率分别为9.8%、19.3%、26.0%、26.0%、26.0%;肝性脑病发生率分别为14.8%、23.9%、35.8%、57.2%、57.2%。结论 介入性门腔分流术治疗门脉高压症所致曲张静脉出血及腹水疗效可靠。如应用覆膜支架,门腔分流道通畅率较高。肝性脑病及复发性出血等并发症的发生率较低。     

裸金属支架与PTFE-覆膜支架行TIPSS治疗门静脉高压症患者临床疗效对比研究

目的 使用裸金属支架（BMS）和聚四氟乙烯（PTFE）覆膜支架行经颈静脉肝内门腔静脉支架分流术（TIPSS）治疗门静脉高压症患者临床疗效和技术设备成本对比分析。方法 2010年5月～2015年6月对163例门静脉高压症患者行TIPSS术,患者平均年龄为（56±12） 岁,女性占32.9 %。其中接受BMS支架80例,接受覆膜支架83例。结果 本组技术成功率为97.5%,术后门体梯度压从（16.1±4.8） mmHg下降至（5.1±2.1） mmHg;两组技术成功率和门体梯度压降无显著性差异;Kaplan-Meier分析显示,两组14 d、6 m和2 a一期支架通畅率存在显著性差别,其中PTFE-覆膜支架组通畅率高;两组1 a生存率和肝性脑病发生率无显著性差异;金属支架和覆膜支架总成本分别为66570元和70455元。结论 TIPSS术是一种安全、有效的治疗门静脉高压症的方法。裸金属支架和PTFE-覆膜支架均具有良好的技术和临床效果,并发症发生率低。     

Prevention of recurrent esophageal variceal hemorrhage: review and current recommendations

Variceal rebleeding is a very frequent and severe complication in cirrhotic patients; therefore, its prevention should be mandatory. Lately several studies demonstrated that the rate of rebleeding was decreased by 40% and overall survival is improved by 20% with beta-blockers. However, this treatment presents some problems, such as the number of nonresponders and contraindications for its use. Recent trials found that the combination of beta-blockers with mononitrate of isosorbide to be superior to beta-blockade alone. Furthermore, endoscopic band ligation also shown to decrease the frequency of rebleeding, complications, and death compared with sclerotherapy and should be the preferred endoscopic treatment. In addition, the comparison between combined pharmacologic treatment with endoscopic treatment present similar rebleeding and mortality rates. More recently, the addition of nadolol to endoscopic band ligation increased the efficacy of endoscopy alone in the prevention of variceal rebleeding. These studies suggest that banding plus drugs could be the treatment of choice for the prophylaxis of rebleeding. When these treatments fail, the recommendation is to use transjugular intrahepatic portosystemic shunt (TIPS) or surgical shunts. Both treatments are effective in preventing rebleeding; however, they are associated with a greater risk of encephalopathy. The comparison of portacaval shunts with TIPS demonstrated that TIPS patients presented higher rebleeding, treatment failure, and transplantation. Another randomized controlled trial comparing distal splenorenal shunt with TIPS shows that variceal rebleeding was similar in both groups without differences in encephalopathy and mortality. The only difference observed was the higher rate of reintervention observed in the TIPS group to maintain his patency.     

Transjugular intrahepatic portosystemic shunt vs endoscopic therapy in preventing variceal rebleeding

AIM:To compare early use of transjugular intrahepatic portosystemic shunt(TIPS) with endoscopic treatment(ET) for the prophylaxis of recurrent variceal bleeding.METHODS:In-patient data were collected from 190 patients between January 2007 and June 2010 who suffured from variceal bleeding.Patients who were older than 75 years;previously received surgical treatment or endoscopic therapy for variceal bleeding;and complicated with hepatic encephalopathy or hepatic cancer,were excluded from this research.Thirty-five cases lost to follow-up were also excluded.Retrospective analysis was done in 126 eligible cases.Among them,64 patients received TIPS(TIPS group) while 62 patients received endoscopic therapy(ET group).The relevant data were collected by patient review or telephone calls.The occurrence of rebleeding,hepatic encephalopathy or other complications,survival rateand cost of treatment were compared between the two groups.RESULTS:During the follow-up period(median,20.7 and 18.7 mo in TIPS and ET groups,respectively),rebleeding from any source occurred in 11 patients in the TIPS group as compared with 31 patients in the ET group(Kaplan-Meier analysis and log-rank test,P = 0.000).Rebleeding rates at any time point(6 wk,1 year and 2 year) in the TIPS group were lower than in the ET group(Bonferroni correction α' = α/3).Eight patients in the TIPS group and 16 in the ET group died with the cumulative survival rates of 80.6% and 64.9%(Kaplan-Meier analysis and log-rank test c2 = 4.864,P = 0.02),respectively.There was no significant difference between the two groups with respect to 6-wk survival rates(Bonferroni correction α' = α/3).However,significant differences were observed between the two groups in the 1-year survival rates(92% and 79%) and the 2-year survival rates(89% and 64.9%)(Bonferroni correction α' = α/3).No significant differences were observed between the two treatment groups in the occurrence of hepatic encephalopathy(12 patients in TIPS group and 5 in ET group,KaplanMeier analysis and log-rank test,c2 = 3.103,P = 0.08).The average total cost for the TIPS group was higher than for ET group(Wilcxon-Mann Whitney test,52 678 RMB vs 38 844 RMB,P 0.05),but hospitalization frequency and hospital stay during follow-up period were lower(Wilcxon-Mann Whitney test,0.4 d vs 1.3 d,P = 0.01;5 d vs 19 d,P 0.05).CONCLUSION:Early use of TIPS is more effective than endoscopic treatment in preventing variceal rebleeding and improving survival rate,and does not increase occurrence of hepatic encephalopathy.     

经颈静脉肝内门体分流术联合胃冠状静脉栓塞术降低曲张静脉再出血率的研究

目的 比较经颈静脉肝内门体分流术(TIPS)及TIPS联合胃冠状静脉栓塞术后的食管胃底静脉曲张再出血率.方法 根据TIPS前1周活动性出血情况,将122例肝硬化食管胃底静脉曲张二级预防再出血患者分别纳入分流组44例,给予TIPS;分流联合断流组78例,给予TIPS联合胃冠状静脉栓塞术.术后随访1年,比较两组的再出血率、支架通畅率及病死率.计量资料用成组设计的t检验,计数资料用Χ2检验,累积曲张静脉再出血率、累积支架通畅率、累积生存率用乘积极限法描述,用Log-rank法进行统计学检验,并将支架通畅率与再出血率及再出血率与生存率做Pearson's相关分析.结果 分流组1年再出血率为41.5%,分流联合断流组为19.5%,两组比较,Χ2=6.320,P=0.012,差异有统计学意义.两组1年支架通畅率及病死率比较,P值均>0.05,差异均无统计学意义.结论 TIPS联合胃冠状静脉栓塞术较单纯TIPS可降低术后1年内的再出血率.

Abstract：

Objective To prospectively compare the rates of gastroesophageal variceal rebleeding in patients underwent TIPS alone and TIPS combined with embolization of gastric coronary veins. Methods According to the bleeding state within one week before the shunt placement, 122 patients with hepatic cirrhosis indicated for the secondary prevention of gastroesophageal variceal rebleeding were allocated to the shunt group (n = 44, treated with TIPS alone) and the shunt plus embolization group (n = 78, treated with TIPS combined with embolization of gastric coronary veins). All the patients were followed up for 1 year, and the 1-year cumulative rates of rebleeding, shunt patency and mortality were compared. Results The basic characteristics of patients in the two groups were comparable (P > 0.05). The 1-year cumulative re-bleeding rates were 41.5% in the shunt group and 19.5% in the shunt combined with embolization group (χ2 = 6.320, P = 0.012). The differences of 1-year cumulative rates of shunt patency and mortality between the two groups were not significant (P > 0.05). Conclusions TIPS combined with embolization of gastric coronary veins could reduce significantly the rate of rebleeding in 1 year after the shunt placement as compared with TIPS alone.