肝硬化食管胃底静脉曲张破裂出血的急诊TIPS术可行性

Feasibility of emergency transjugular intrahepatic portosystemic shunt operation for acute esophageal variceal bleeding in liver cirrhosis

目的探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)用于急性肝硬化食管胃静脉曲张破裂出血的可行性。方法选择2011年9月至2013年9月收治的28例急性肝硬化食管胃静脉曲张破裂出血患者,均实施急诊TIPS术。结果 28例患者均1次操作成功接受TIPS术,术后24 h的止血率为100.0%。患者的平均门静脉压力术后较术前显著下降,分别为(27.01±5.32)和(38.23±7.41)cmH2O,门体循环压力差显著减小,分别为(18.76±4.70)和(30.45±7.69)cmH2O,经比较差异均有统计学意义(t=9.56,8.74,均P<0.05)。术后,患者肝功能各项指标及凝血酶原时间较之术前均未出现显著改变,经比较差异均无统计学意义,(均P>0.05)。术后随访3个月,所有患者支架均通畅,1例分流道为门静脉左支患者出现狭窄闭塞。1例患者出现肝性脑病,1例患者出现肝功能衰竭,经治疗无效死亡。结论急诊TIPS术用于急性肝硬化食管胃静脉曲张破裂出血可以获得良好的效果,安全性高。

Objective To explore the feasibility of emergency transjugular intrahepatic portosystemic shunt （TIPS） for acute esophageal variceal bleeding in liver cirrhosis.Methods Twenty-eight patients with acute hemorrhage of esophageal and gastric varices in our hospital from September 201 1 to September 2013 were enrolled,and received implementation of emergency TIPS operation.Results Postoperative 24h hemostatic rate of all the 28 patients received TIPS operation successfully was 1 00%.Average postoperative portal vein pressure and portosystemic pressure decreased significantly,which showed statistically significant differences （t=9.56,8.74,P0.05）.After a follow up of 3 months,stents in all patients were unimpeded except where below：stenosis and occlusion occurred in one patient whose shunt was via the left branch of portal vein;one patient developed hepatic encephalopathy;one patient died from liver failure.Conclusion Emergency TIPS for acute esophageal variceal bleeding due to liver cirrhosis can obtain good efficacy and safety,with high feasibility of clinical application.