TIPS和PTVE治疗肝硬化食管胃底静脉曲张破裂出血的临床效果比较

Comparison of the efficacy transjugular intrahepatic portosystemic shunt and percutaneous transhepatic variceal embolization for cirrhosis with esophageal gastric varices bleeding

目的探讨经颈静脉肝内门体分流术(TIPS)和经皮经肝胃冠状静脉栓塞术(PTVE)对肝硬化食管胃底静脉曲张破裂出血的疗效。方法回顾性分析因肝硬化食管胃底静脉曲张破裂出血就诊并实施介入治疗的61例患者资料,其中PTVE组42例,TIPS组19例。比较2组治疗成功率、再出血率、曲张静脉缓解情况、肝性脑病发生率、生存率及肝功能变化等。结果 2组手术均成功,TIPS组术后门静脉压力明显下降,PTVE组的再出血率为78.6%,高于TIPS组的63.2%,PTVE组术后食管胃底静脉曲张缓解的有效率为50.0%,明显低于TIPS组的89.5%(均P<0.05);PTVE组和TIPS组肝性脑病发生率分别为14.3%和26.3%,2年累积生存率分别为95.2%和89.5%,差异均无统计学意义;PTVE组术后各时期肝功变化与术前差异无统计学意义;TIPS组术后1、3个月肝功能较术前及PTVE术后同一时期下降,术后6、12个月肝功能变化与术前及PTVE术后同一时期相比差异无统计学意义。结论 TIPS治疗肝硬化食管胃底静脉曲张破裂出血手术安全,再出血率低,食管胃底静脉曲张好转快,术后中远期对肝功能影响较小,是一种理想的介入治疗方法。

Objective To explore the clinical effect of transjugular intrahepatic portosystemic shunt （TIPS） and percutaneous transhepatic variceal embolization （PTVE） on the treatment of cirrhosis with esophageal gastric varices bleeding. Methods The data of 61 patients of liver cirrhosis combined with esophageal gastric varices bleeding who underwent the interventional treatment were included in the retrospective analysis. Patients were divided into two groups, PTVE treatment group （n=42）, and TIPS treatment group （n=19）. The success rate of clinical treatment, the rebleeding rate, the alleviation of varicose veins, the incidence of hepatic encephalopathy, survival rate and liver function parameters were compared between two groups. Results Two groups of surgery were successful. The portal vein pressure decreased obviously in TIPS group. The rebleeding rate was higher in PTVE group （78.6%） than that in TIPS group （63.2%）. The total alleviation rate of esophageal gastric varices was significantly lower in PTVE group （50.0%） than that in TIPS group （89.5%, P〈0.05）. The incidence rates of hepatic encephalopathy were 14.3% and 26.3% for PTVE group and TIPS group respectively. The two-year cumulative survival rates of PTVE group and TIPS group were 95.2% and 89.5% respectively, and there was no statistically significant difference between two groups. After surgery, the liver function parameters were not significantly different from those determined before the treatment in PTVE group. At 1 month and 3 months after TIPS, the liver functions were declined obviously. At 6 and 12 months after the treatment, the liver functions were not significantly different from those determined before the treatment in PTVE group. Conclusion The surgery of TIPS is safe and ideal interventional treatment for cirrhosis with esophageal gastric varices bleeding, which has the lower rebleeding rate, better esophageal gastric varices alleviation rate and long term less influence in liver function.