药物联合内镜治疗与经颈静脉肝内门体分流术对肝硬化食管胃静脉曲张出血的疗效分析

目的比较药物联合内镜治疗及经颈静脉肝内门体分流术(TIPS)对急性肝硬化食管胃静脉曲张出血(EGVB)的近期及远期疗效。方法收集2010年1月-2014年12月住院行药物联合内镜下治疗或行TIPS术的肝硬化EGVB患者资料120例,根据治疗方式分为联合治疗组77例,TIPS治疗组43例,比较两组急性期止血情况、远期再出血情况、生存情况及并发症发生情况。结果联合治疗组及TIPS治疗组的急性期止血率无明显差异,分别为96.1%及97.7%,联合治疗组2年未再出血率低于TIPS治疗组(59.7%vs 81.4%,P0.05),且两组间免于再出血函数比较差异有统计学意义(P=0.031)。两组间死亡率无明显差异(10.4%vs 4.7%,P=0.444),联合治疗组肝性脑病发生率低于TIPS治疗组(13.2%vs 27.9%,P0.05)。结论药物联合内镜治疗及TIPS术均能较好地控制EGVB,TIPS术可以更好地防止再出血的发生但会导致更高的肝性脑病发生率。

Drugs combined with endoscopic therapy versus transjugular intrahepatic portosystemic shunt in management of esophageal and gastric variceal bleeding

Abstract: Objective To compare the short term and long term efficacy of drugs combined with endoscopic therapy (ET) and transjugular intrahepatic portosystemic shunt (TIPS) in treatment of esophageal and gastric variceal bleeding (EGVB) in cirrhotic patients. Methods We reviewed 120 cases of patients admitted for acute esophageal and gastric variceal bleeding from January 2010 to December 2014, treated with drugs combined with endoscopy (n = 77) or TIPS (n = 43). The incidence of failure to control bleeding, long term rebleeding, mortality and complications were compared. Results Patients treated with TIPS had a higher probability of remaining free of bleeding or rebleeding than patients receving drugs+ET (59.7% vs. 81.4%, P < 0.05). The incidence of hepatic encephalopathy in the drugs + ET group was lower than that in the TIPS group (13.2% vs 27.9%, P < 0.05). There was no significant difference in the control of acute bleeding (96.1% vs 97.7%, P > 0.05) and mortality (10.4% vs. 4.7%, P > 0.05) between the two groups. Conclusions Both drugs+ET and TIPS surgery can control EGVB well, TIPS can better prevent the occurrence of rebleeding but will lead to a higher incidence of hepatic encephalopathy.