经颈静脉肝内门体分流术联合胃冠状静脉栓塞治疗食管胃底静脉曲张破裂出血

Transjugular intrahepatic portosystemic shunt combined with gastric coronary vein embolization in treatment of gastroesophageal varices bleeding

目的探讨经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞治疗食管胃底静脉曲张破裂出血的疗效。方法回顾性分析70例接受TIPS治疗食管胃底静脉曲张破裂出血患者的临床资料,其中15例患者单独接受TIPS治疗(非栓塞组),55例患者接受TIPS联合胃冠状静脉栓塞术治疗(栓塞组),比较两组治疗方法的临床疗效。结果所有TIPS手术操作均成功完成。栓塞组和非栓塞组患者术后12个月累积无消化道再出血率分别为77.33%和86.67%(P=0.30),分流道累积通畅率分别为74.10%和83.33%(P=0.30);栓塞组患者术后12、24个月累积生存率分别为90.38%和82.85%,而非栓塞组分别为93.33%和82.96%,两组比较差异无统计学意义(P=0.62)。栓塞组和非栓塞组患者术后肝性脑病发生率分别为18.18%(10/55)和40.00%(6/15),差异无统计学意义(P=0.15)。结论与单独TIPS相比,TIPS联合胃冠状静脉栓塞并未提高食管胃底静脉曲张破裂出血的疗效。

Objective To assess the efficacy of transjugular intrahepatic portosystemic shunt （TIPS） combined with gas- tric coronary vein embolization （GCVE） in patients with gastroesophageal varices bleeding. Methods Clinical datum of 70 patients of gastroesophageal varices bleeding were analyzed retrospectively. All patients were divided into TIPS group （n= 15） and TIPS＋GCVE group （n=55）. The curative effect was compared between two groups. Results All TIPS were technically successful. The free of variceal rebleeding rates in TIPS＋GCVE group and TIPS group were 77.33% and 86. 67% after 12 months （P=0.30）, and stent patency rates in TIPS-I-GCVE group and TIPS group were 74.10% and 83.33% （P=0.30）. Survival rates in TIPS＋GCVE group were 90.38% after 12 months, 82.85% after 24 months, and those in TIPS group were 93.33% after 12 months, 82.96% after 24 months, which had no significant difference between two groups （P=0.62）. The hepatic encephalopathy incidence rate of TIPSnCGCVE group and TIPS group were 18.18% （10/55） and 40.00% （6/15）, respectively, and difference was not statistically significant （P=0.15）. Conclusion As the treatment of gastroesophageal varices bleeding, TIPS combined with GCVE can not improve the efficacy in comparison with TIPS alone.