经颈静脉肝内门体分流术治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

Transjugular intrahepatic portosystemic stent-shunt in treatment of esophagogastric varices bleeding due to cirrhosis

目的探讨经颈静脉肝内门体分流术(TIPS)治疗肝硬化食管胃底静脉曲张破裂出血(EGVB)的临床效果。方法收集35例因肝硬化失代偿期合并EGVB行TIPS术的患者的资料,观察近期疗效,包括术后24h止血率、平均门静脉压力、术后肝功能指标(胆碱脂酶、总胆红素、白蛋白)及凝血酶原时间,并与术前比较,并观察肝性脑病及支架阻塞发生情况。结果 35例患者中34例成功实施TIPS,其中1例因血管变异无法经常规路径进入门静脉。术后24h止血率为100%。34例成功实施TIPS的患者,平均门静脉压力从(38.01±4.75)cmH_2O降低至(25 04±3.14)cmH_2O,手术前、后比较,差异有统计学意义(P<0.01)。胆碱脂酶活性、总胆红素、白蛋白、凝血酶原时间术后3d与术前比较,差异均无统计学意义(均P>0.05)。患者术后随访1~12个月,肝性脑病发生率为14.71%(5/34),其中1例严重肝性脑病患者予以再次行TIPS术置入限流支架,病情好转。早期再出血率(72h^6周)为0%(0/34),迟发性再出血率(6周~12个月)为5.88%(2/34),肝功能衰竭发生率为2.94%(1/34),术后支架阻塞率为5.88%(2/34),病死率为0%(0/34)。结论 TIPS治疗肝硬化食管胃底EGVB效果确切,安全可靠。

Objective To evaluate the application of transjugular intrahepatic portosystemic stent- shunt（TIPS） in treatment of esophagogastric varices bleeding （EGVB） in cirrhosis patients. Methods Thirty five patients with EGVB due to liver cirrhosis received TIPS and were fol owed up for 12 months at the First Affiliated Hospital of Wenzhou Medical University and Wenzhou Central Hospital. The short- term effects, including 24h hemostasis rates after TIPS and average portal pressure were observed. The levels of cholinesterase,total bilirubin,albumin,and prothrombin time were also evaluated after TIPS. The occurrence of hep-atic encephalopathy and obstruction of stents after TIPs were also observed. Results The TIPS was successful y performed in 34 out of 35 patients with a total effective rate of 97.14%and the rate of 24h hemostatsis was 100.0%.Average portal pressure dropped from （38.01±4.75）cmH2O to （25.04±3.14） cmH2O after treatment （P〈0.01）. There were no significant differences in cholinesterase, total bilirubin,albumin, and prothrombin time before and three days after operation（P〉0.05）. The incidence rate of hepatic encephalopathy was 14.71%（5/34）.The relapse rate of early rehemorrhagia （72h to 6 weeks） was 0%（0/34） and that of tardive rehaemorrhagia（6 to 12 months） was 5.88%（2/34）.The incidence rate of hepatic failure was 2.94%（1/34）. The rate of stent obstruction was 5.88%（2/34）. No death occurred in the patients. Conclusion TIPS is effective and safe in treatment of esopha-gogastric varices bleeding caused by liver cirrhosis.