经颈静脉肝内门体分流术与药物联合内镜预防肝硬化食管胃底静脉曲张再出血的比较研究

发布时间：2018-04-20 21:29

本文选题：食管胃底静脉曲张 + 经颈静脉肝内门体分流术　；参考：《中国内镜杂志》2016年10期

【摘要】：目的比较经颈静脉肝内门体分流术(TIPS)与药物联合内镜预防肝硬化食管胃底静脉曲张再出血(EGVB)的效果。方法 2013年5月-2014年10月肝硬化EGVB患者75例为研究对象,采用随机数字表法分为观察组38例和对照组37例,观察组给予TIPS治疗,对照组给予胃镜下硬化剂注射(EIS)治疗,比较两组治疗效果、肝功能、并发症情况,观察TIPS术前后血流动力学变化。结果治疗效果:两组静脉曲张清除率、死亡率和30 d再出血率差异无统计学意义(P0.05);观察组1年再出血率28.95%明显低于对照组51.35%(P0.05);血流动力学:观察组门静脉压(PVP)、门体循环压力差(PSG)和肝静脉压力梯度(HVPG)均明显低于手术前(P0.05);肝功能与血小板计数:观察组白蛋白(ALB)、血小板计数(PLT)明显低于对照组,总胆红素(TBIL)明显高于对照组(P0.05);并发症:两组肝性脑病、新发腹水和肝肾综合征差异无统计学意义(P0.05)。结论 TIPS术与药物联合内镜均能有效预防肝硬化EGVB发生,药物联合内镜治疗有助于保护患者肝功能,TIPS术有助于改善门静脉系统血流动力学状态,TIPS术近期疗效优于药物联合内镜治疗。
[Abstract]:Objective to compare the effect of transjugular intrahepatic portosystemic shunt (TIPS) and drug combined endoscopy in preventing rebleeding of esophageal and gastric fundus varices in liver cirrhosis. Methods from May 2013 to October 2014, 75 patients with EGVB were randomly divided into observation group (n = 38) and control group (n = 37). The observation group was treated with TIPS and the control group was treated with gastroscopic sclerosing agent injection. The therapeutic effect, liver function and complications were compared between the two groups. Hemodynamic changes were observed before and after TIPS. Results: the removal rate of varicose veins in the two groups was higher than that in the control group. There was no significant difference in mortality and re-bleeding rate at 30 days (P 0.05), the annual rebleeding rate in the observation group was 28.95% significantly lower than that in the control group (51.35%). Hemodynamics: portal vein pressure, portal venous pressure difference (PSG) and hepatic vein pressure gradient (HVPGs) in the observation group were significantly lower than those in the control group (P < 0.05). The liver function and platelet count in the observation group were significantly lower than those in the control group. TBILs of total bilirubin were significantly higher than those of control group (P 0.05). Complications: there was no significant difference between the two groups in hepatic encephalopathy, new ascites and hepatorenal syndrome (P 0.05). Conclusion TIPS combined with drug endoscopy can effectively prevent the occurrence of EGVB in patients with liver cirrhosis. Combination of drugs and endoscopy can protect liver function and improve the hemodynamics of portal vein system.
【作者单位】：青海大学附属医院介入科;
【分类号】：R575.21

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