超声引导下门静脉穿刺导引TIPS联合曲张静脉栓塞治疗肝硬化上消化道出血

目的探讨超声引导下经皮经肝穿刺门静脉导引TIPS联合食管胃底曲张静脉栓塞术(PTVE)治疗肝硬化上消化道出血的临床价值。方法收集82例肝硬化伴反复上消化道出血患者,对其中47例(病例组)采用超声引导下经皮经肝门静脉穿刺并导引TIPS联合PTVE,对35例(对照组)采用传统TIPS路径联合PTVE。比较2组分流道穿刺次数及时长、PTVE完成时长及手术总时长等指标,分别比较2组手术前后肝脏血管情况。记录2组并发症。结果病例组分流道穿刺次数和时长、手术总时长及术中出血率均低于对照组,而分流道穿刺成功率高于对照组(P均0.05);2组PTVE手术时长差异无统计学意义(P=0.15)。与术前相比,2组术后门静脉及脾静脉内径均缩小;门静脉、脾静脉、肠系膜上静脉及下腔静脉流速均加快,肝动脉流速均减低、RI均增高(P均0.05)。病例组无复发消化道出血病例,对照组3例(3/35,8.57%)复发消化道出血(t=3.15,P0.001)。结论超声引导下门静脉穿刺导引TIPS及PTVE可缩短手术时间、提高手术成功率及降低术后复发消化道出血的风险。

Ultrasound-guided portal vein puncture for TIPS combined with percutaneous transhepatic variceal embolization in treatment of upper gastrointestinal hemorrhage in patients with liver cirrhosis

Objective To observe the clinical value of ultrasound-guided portal vein puncture for TIPS combined with percutaneous transhepatic variceal embolization (PTVE) in the treatment of upper gastrointestinal hemorrhage in patients with liver cirrhosis. Methods Totally 82 patients with recurrent upper gastrointestinal bleeding caused by liver cirrhosis were collected. Ultrasound-guided percutaneous transhepatic portal vein puncture and TIPS combined with PTVE were performed in 47 patients (case group), while traditional TIPS combined with PTVE were performed in 35 patients (control group). Indexes of the number and time of punctures, PTVE completion time and total operation time were compared between the two groups. Vascular status and complications before and after operation were compared, respectively. The complications of the two groups were recorded. Results The number and times of puncture, total operation time and intraoperative bleeding rate of case group were all lower than those of control group, and the success rate of puncture was higher than that of control group (all P<0.05). There was no significant difference of PTVE completion time between the two groups (P=0.15). Compared with preoperation, the inner diameter of portal vein and splenic vein reduced, the blood flow velocity of portal vein, splenic vein, superior mesenteric vein and inferior vena cava all increased, the velocity of the hepatic artery decreased, and RI increased in both two groups (all P<0.05). Recurrent gastrointestinal bleeding was not found in case group, whereas was found in 3 patients (3/35, 8.57%) in control group (t=3.15, P<0.001). Conclusion TIPS combined with PTVE and ultrasound-guided portal vein puncture can shorten the operation time, increase the success rate and reduce the risk of recurrent gastrointestinal bleeding.