经颈静脉肝内门体分流术治疗肝硬化合并食管胃底静脉曲张破裂出血的研究

目的 探讨经颈静脉肝内门体分流术(TIPS)治疗肝硬化合并食管胃底静脉曲张破裂出血(EGVB)的临床效果.方法 收集本院因肝硬化失代偿期合并EGVB行急诊TIPS术的患者资料,观察近期疗效,包括术后24 h止血率、术后门体循环压力差和平均门静脉压力、术后肝功能指标(白蛋白、胆碱脂酶、总胆红素)情况、凝血酶原时间等并与术前各指标比较.计量资料用配对t检验进行分析.结果 共收集39例患者资料,其中37例成功实施TIPS.另外2例患者,1例因血管变异无法经常规路径进入门静脉;1例因肝脏体积明显缩小,大量腹水等原因穿刺门静脉未成功,均改为经皮穿刺门静脉,成功行胃冠状静脉栓塞术.术后24 h止血率为100%.37例成功实施TIPS的患者,门体循环压力差从(30.44±7.68)cm H2O(1 cmH2O=0.098 kPa)降低至(18.78±4.71)cmH2O;平均门静脉压力从(38.22±7.40)cmH2O降低至(27.00±5.38)cmH2O,手术前后比较,t值分别为11.348、13.363,P值均<0.01,差异均有统计学意义.白蛋白、胆碱脂酶活性、总胆红素、凝血酶原时间术后与术前比较,差异均无统计学意义(P值均>0.05).患者均随访1～12个月,术后支架狭窄发生率为5.71%(2/35),肝性脑病发生率为13.51%(5/37),再出血复发率为2.86%(1/35),肝功能衰竭发生率为2.70%(1/37),患者死亡率为8.57%(3/35).结论 TIPS治疗急性肝硬化食管胃底静脉曲张破裂出血效果确切,安全可靠.

Abstract：

Objective To investigate the effects of transjugular intrahepatic portosystemic stentshunt (TIPS) in emergency treatment of esophagogastric varices bleeding for the cirrhosis patients. Methods 39 cases with esophageal and gastric varices bleeding due to liver cirrhosis received TIPS and were followed-up for 1 to 12 months, the short-term effects incuding 24 hours haemostasis rates post TIPS, pressure gradient between portal vein and systemic circulation, average pressure of portal vein were observed. The levels of albumin, cholinesterase, total bilirubin and prothrombin time post TIPS were also evaluated were observed and evaluated. Results 37 cases received TIPS successfully among the 39 patients, with a total effective rate of 94.87% (37/39) and the rate of hemostatsis in 24 hours was 100%. PSG dropped from (30.44±7.68)cm H2O to (18.78 ± 4.71) cm H2O, mean portal pressure declined from (38.22±7.40) cm H2O to (27.00± 5.38) cm H2O (P < 0.01). No significant differences existed at the level of albumin(A) and cholinesterase (CHE) before and after operation (P > 0.05). The relapse rate of frame stenosis was 5.71% (2/35). The incidence rate of hepatic encephalopathy was 13.51% (5/37). The relapse rate of rehaemorrhagia was 2.86% (1/35). The incidence rate of hepatic failure was 2.70% (1/37). The death rate was 5.71% (2/35). Conclusion The effect of TIPS in treating portal hypertension caused by liver cirrhosis is prominent and safe, and is worthy of clinical application.

Clinical application of the transjugular intrahepatic portosystemic stent-shunt in the emergency treatment of esophagogastric varices bleeding due to cirrhosis

Objective To investigate the effects of transjugular intrahepatic portosystemic stentshunt (TIPS) in emergency treatment of esophagogastric varices bleeding for the cirrhosis patients. Methods 39 cases with esophageal and gastric varices bleeding due to liver cirrhosis received TIPS and were followed-up for 1 to 12 months, the short-term effects incuding 24 hours haemostasis rates post TIPS, pressure gradient between portal vein and systemic circulation, average pressure of portal vein were observed. The levels of albumin, cholinesterase, total bilirubin and prothrombin time post TIPS were also evaluated were observed and evaluated. Results 37 cases received TIPS successfully among the 39 patients, with a total effective rate of 94.87% (37/39) and the rate of hemostatsis in 24 hours was 100%. PSG dropped from (30.44±7.68)cm H2O to (18.78 ± 4.71) cm H2O, mean portal pressure declined from (38.22±7.40) cm H2O to (27.00± 5.38) cm H2O (P < 0.01). No significant differences existed at the level of albumin(A) and cholinesterase (CHE) before and after operation (P > 0.05). The relapse rate of frame stenosis was 5.71% (2/35). The incidence rate of hepatic encephalopathy was 13.51% (5/37). The relapse rate of rehaemorrhagia was 2.86% (1/35). The incidence rate of hepatic failure was 2.70% (1/37). The death rate was 5.71% (2/35). Conclusion The effect of TIPS in treating portal hypertension caused by liver cirrhosis is prominent and safe, and is worthy of clinical application.