急诊经颈静脉肝内门体分流术治疗肝硬化静脉曲张出血的疗效评价

发布时间：2018-04-19 19:30

本文选题：肝硬化 + 静脉曲张　；参考：《中国临床医学影像杂志》2017年12期

【摘要】：目的 :评价应用急诊经颈静脉肝内门体分流术(TIPS)治疗肝硬化门脉高压症所致的食管胃静脉曲张破裂出血(EGVB)患者的安全性及有效性。方法:回顾性分析14例于我院急诊行TIPS术治疗的EGVB患者的资料,观察术后止血情况、肝静脉压力梯度(HVPG)、肝功能、术后并发症、再出血情况及支架再闭塞情况等。计量资料采用配对t检验进行分析。结果:14例患者均成功完成急诊TIPS手术,围手术期无严重并发症发生。术中测量HVPG由术前(38.9±9.0)cm H_2O降为术后(19.1±7.0)cm H_2O,差异均有统计学意义,手术前后患者肝功能无明显差异。所有患者术后72 h内出血停止,手术止血率100%。随访3~12月,1例患者因消化道穿孔死亡,1例术后进行肝移植,其余12例状态良好,2例发生肝性脑病(2期),随访期内无患者出现再出血,应用超声及CT随访未发现支架阻塞。结论:对于急性EGVB的肝硬化门脉高压症患者,急诊TIPS治疗安全可行,疗效令人满意。
[Abstract]:Objective: To evaluate the safety and effectiveness of emergency transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of patients with esophageal and gastric variceal bleeding (EGVB) caused by cirrhosis of the portal hypertension. Methods: a retrospective analysis of the data of 14 cases of EGVB patients treated with TIPS in emergency department of our hospital, the postoperative hemostatic situation and the hepatic venous pressure ladder were observed. Degree (HVPG), liver function, postoperative complications, rebleeding and stent reocclusion. Measurement data were analyzed by paired t test. Results: all 14 patients successfully completed emergency TIPS surgery and no serious complications occurred during the perioperative period. The measurement of HVPG was reduced to (19.1 + 7) cm H_2O before operation (19.1 + 7) before operation. There was no significant difference in liver function between the patients before and after operation. The bleeding stopped at 72 h after operation in all patients, the bleeding rate of 100%. was followed up for 3~12 months, 1 patients died of digestive tract perforation, 1 cases had liver transplantation, the rest 12 cases were in good condition, 2 cases had hepatic encephalopathy (2 phase), no rebleeding was found in the follow-up period, ultrasound and CT were used. No stent obstruction was found. Conclusion: emergency TIPS is safe and effective for patients with acute EGVB cirrhosis and portal hypertension.

【作者单位】：中国医科大学附属盛京医院放射科;
【基金】：辽宁省博士科研启动基金计划资助项目(20141047)
【分类号】：R575.2

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