经颈静脉肝内门体分流术与药物联合内镜预防肝硬化食管胃底静脉曲张再出血的比较研究

Comparison of transjugular intrahepatic portosystemic shunt and drugs combined with endoscopy on preventing cirrhosis esophageal and gastric fundal varices re-bleeding

目的比较经颈静脉肝内门体分流术(TIPS)与药物联合内镜预防肝硬化食管胃底静脉曲张再出血(EGVB)的效果。方法 2013年5月-2014年10月肝硬化EGVB患者75例为研究对象,采用随机数字表法分为观察组38例和对照组37例,观察组给予TIPS治疗,对照组给予胃镜下硬化剂注射(EIS)治疗,比较两组治疗效果、肝功能、并发症情况,观察TIPS术前后血流动力学变化。结果治疗效果:两组静脉曲张清除率、死亡率和30 d再出血率差异无统计学意义(P>0.05);观察组1年再出血率28.95%明显低于对照组51.35%(P<0.05);血流动力学:观察组门静脉压(PVP)、门体循环压力差(PSG)和肝静脉压力梯度(HVPG)均明显低于手术前(P<0.05);肝功能与血小板计数:观察组白蛋白(ALB)、血小板计数(PLT)明显低于对照组,总胆红素(TBIL)明显高于对照组(P<0.05);并发症:两组肝性脑病、新发腹水和肝肾综合征差异无统计学意义(P>0.05)。结论 TIPS术与药物联合内镜均能有效预防肝硬化EGVB发生,药物联合内镜治疗有助于保护患者肝功能,TIPS术有助于改善门静脉系统血流动力学状态,TIPS术近期疗效优于药物联合内镜治疗。

ObjectiveTo compare the effect of transjugular intrahepatic portosystemic shunt （TIPS） and drugs combined with endoscopy on preventing cirrhosis esophageal and gastric fundal varices re-bleeding. Methods75 cases of patients with cirrhosis gastric fundal varices re-bleeding from May 2013 to October 2014 were divided into observation group （38 cases） and control group （37 cases）. Patients in observation group received TIPS treatment, while patients in control group received endoscopic sclerotherapy. The treatment effect, liver function and complications of the two groups were compared, and hemodynamic changes before and after TIPS were observed. ResultsTreatment effect： varicose clearance rate, mortality rate and 30 d re-bleeding rate of the two groups have no statistical significance （P 〉0.05）; 1-year re-bleeding rate in observation group was 28.95 % and significantly lower than 51.35 % in control group （P 〈0.05）; hemodynamics： portal venous pressure （PVP）, portal-systemic circulation pressure gradient （PSG） and hepatic venous pressure gradient （HVPG） of observation group were significantly lower than those before operation （P 〈0.05）; liver function and platelet count： albumin （ALB） and platelet count （PLT） of observation group were significantly lower than those of control group, and total bilirubin （TBIL） was significantly higher than that of control group （P 〈0.05）; complications： differences in hepatic encephalopathy, new ascites and hepatorenal syndrome of the two groups have no statistical significance （P 〉0.05）. ConclusionBoth TIPS and drugs combined with endoscopy can effectively prevent cirrhosis esophageal and gastric fundal varices re-bleeding, drug combined with endoscopy therapy helps to protect patients’ liver function, TIPS helps to improve hemodynamic status of portal system, and short-term outcome of TIPS is better than that of drug combined with endoscopy therapy.