经颈内静脉肝内门体静脉分流术预防肝硬化门静脉高压合并食管胃底静脉曲张破裂出血的效果研究

目的 探讨经颈内静脉肝内门体静脉分流术(T IPS)对肝硬化门静脉高压合并食管胃底静脉曲张破裂出血的临床防治效果.方法 将四川大学华西医院2015年4月至2017年5月收治的85例肝硬化食管胃底静脉曲张患者根据治疗方法不同分为治疗组(n=45)和对照组(n=40),前者行TIPS术治疗,后者予内镜下套扎与硬化剂注射(EIS)治疗.统计两组治疗后静脉曲张清除率、再出血率等,并记录两组治疗前后血流动力学及血清肝功能指标水平变化.结果 治疗组治疗后静脉曲张清除率(95.56%)明显高于对照组(80.00%),且治疗后60 d再出血率(11.11%)明显低于对照组(30.00%),差异有统计学意义(P<0.05).治疗组术后支架通畅率为97.78%,仅1例发生支架堵塞,予再通、球囊扩张治疗后通畅.两组治疗前各项血流动力学指标与血清肝功能指标水平比较差异无统计学意义(P>0.05),治疗后门静脉压(PVP)、门体循环压力差(PSG)、肝静脉压力梯度(HVPG)、门静脉血流量(QPV)均明显降低,且治疗组上述指标降低幅度均明显较对照组大(P<0.05);两组治疗后30 d血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、胆红素(TBIL)水平均较治疗前明显改善,但与对照组相比,治疗组血清TBIL水平明显高,ALB、PLT明显低,差异有统计学意义(P<0.05).结论 与内镜联合药物防治肝硬化食管胃底静脉曲张破裂出血相比,T IPS术在清除静脉曲张、预防再出血、改善门静脉系统血流动力学状态及保护肝功能方面均有突出的优势.

Effect of Transjugular Intrahepatic Portosystemic Shunt on the Prevention of Portal Hypertension Complicated with Gastroesophageal Variceal Hemorrhage in Patients with Cirrhosis

Objective To investigate the clinical effect of transjugular intrahepatic portosystemic shunt (TIPS) on the prevention of portal hypertension complicated with gastroesophageal variceal hemorrhage in patients with cirrhosis .Methods A total of 85 patients with liver cirrhosis and gastroesophageal varices treated in West China Hospital of Sichuan University from April of 2015 to May of 2017 were divided into the treatment group (n=45) and the control group (n=40) according to the different treatment methods .The former group was treated by TIPS while the latter group was treated with endoscopic ligation and endoscopic injection sclerotherapy (EIS) .The variceal clearance rates and rebleeding rates in the two groups were statistically analyzed after treatment and the changes in the indexes of hemodynamics and liver function were recorded before and after treatment in the two groups .Results After treatment ,the variceal clearance rate of the treatment group (95.56% ) was higher than that of the control group (80.00% ) the rebleeding rate at 60d after treatment in the treatment group was 11.11%and it was higher than that in the control group which was 30.00% ,and the differences were statistically different (P<0.05) .The patency rate of stent was 97.78% after treatment in the treatment group and there was only 1 case of stent blockage which was treated successfully with recanalization and balloon dilatation . The indexes of hemodynamics and liver function showed no significant differences between the two groups before treatment (P>0.05) ,while the portal venous pressure (PVP) ,portosystemic pressure difference (PSG) ,hepatic venous pressure gradient (HVPG) and blood quantities of portal vein (QPV) were decreased significantly after treatment (P>0.05) and the decreases in the treatment group were significantly greater than those in the control group (P<0.05) .The levels of serum alanine aminotransferase (ALT) ,aspartate aminotransferase (AST) and bilirubin (TBIL) in the two groups were improved significantly at 30d after treatment ,while the TBIL level was significantly higher and the levels of ALB and PLT were significantly lower in the treatment group than in the control group (P<0.05) .Conclusion Compared with endoscopy combined with drugs for the prevention and treatment of the gastroesophageal variceal hemorrhage in patients with cirrhosis ,TIPS has more prominent advantages in removing the varicose veins ,preventing rebleeding ,improving the hemodynamics of portal system and protecting the liver function .