TIPS联合胃冠状静脉栓塞治疗肝硬化门静脉高压伴上消化道出血

发布时间：2018-10-31 10:52

【摘要】：目的对比单纯TIPS和TIPS联合胃冠状静脉栓塞术(GCVE)治疗肝硬化门静脉高压症(PHT)伴上消化道出血(UGH),分析TIPS和GCVE联合应用的必要性、可行性及临床疗效。方法回顾性分析2010年4月至2012年5月收治的38例PHT伴UGH患者临床资料,其中接受单纯TIPS治疗15例(A组),TIPS联合GCVE治疗23例(B组),观察分析手术前后血液指标、门静脉及脾脏血流动力学、脾脏形态学、消化道静脉曲张程度变化。随访术后并发症发生情况。结果两组术后门静脉压降低、流速加快、脾静脉淤血指数降低均较术前明显(P0.05),B组均优于A组(P0.05)。术后两组食管胃底静脉曲张(EGV)均明显好转(P0.05),B组和A组EGV好转率分别为94.7%、66.6%,急诊止血率分别为100%、75%,再出血率分别为4.3%、28.5%,B组均明显优于A组(P0.05)。手术前后肝功能指标组内、组间比较,差异均无统计学意义(P0.05)。两组术后肝性脑病(HE)发生率、支架原发通畅率差异均无统计学意义(P0.05)。两组再介入通畅率均为100%,支架远端位于门静脉左支者HE发生率显著低于位于右支者(P0.05)。结论 TIPS联合GCVE治疗肝硬化PHT伴UGH疗效确切,优于单纯TIPS。
[Abstract]:Objective to compare the necessity, feasibility and clinical efficacy of TIPS and TIPS combined with gastric coronary vein embolization (GCVE) in the treatment of portal hypertension (PHT) with upper gastrointestinal hemorrhage. Methods the clinical data of 38 PHT patients with UGH were retrospectively analyzed from April 2010 to May 2012, of which 15 cases were treated with TIPS alone (Group A,), TIPS combined with GCVE, 23 cases, Group B). The blood indexes before and after operation were observed and analyzed. The hemodynamics of portal vein and spleen, the morphology of spleen and the degree of digestive tract varices. Postoperative complications were followed up. Results the portal vein pressure decreased, the velocity of blood flow accelerated and the index of splenic vein congestion decreased significantly in both groups (P0.05) compared with that before operation (P0.05) in), B group was better than that in A group (P0.05). The (EGV) of esophageal and gastric fundus varices in the two groups were improved significantly after operation (P 0.05, the improvement rates of EGV in group), B and group A were 94.7and 66.6, respectively. The emergency hemostatic rate was 10075 and the rate of rebleeding was 4.3, respectively. Group B was significantly better than group A (P0.05). There was no significant difference in liver function between groups before and after operation (P0.05). There was no significant difference in the incidence of (HE) and the primary patency rate of stent between the two groups (P0.05). The patency rate of re-intervention in both groups was 100. The incidence of HE in patients with distal stent located in the left portal vein was significantly lower than that in the right branch (P0.05). Conclusion TIPS combined with GCVE is more effective than TIPS. alone in the treatment of PHT with UGH in cirrhotic patients.
【作者单位】：成都军区昆明总医院血管外科;昆明医科大学第一附属医院医学影像中心;
【分类号】：R575.2

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