门静脉高压断流术后再出血的治疗

Clinical cure for the recurrent upper gastrointestinal bleeding in portal hypertension patients after pericardial devascularization

目的探讨和分析门静脉高压断流术后再出血的治疗措施。方法对武汉大学中南医院自2013年1月至2015年6月收治门静脉高压断流术后再出血病人60例的临床治疗进行回顾性分析。60例病人中,25例病人采用内镜下套扎止血,20例病人行经颈静脉肝内门静脉分流术(transjugular intrahepatic portosystemic shunt,TIPS),10例病人行肝移植,5例复发重度食管静脉曲张行再次断流术。结果内镜套扎组8例病人因再次出血行第2次内镜下套扎,其中1例病人再次大出血死亡;行TIPS组2例发生间断性肝性脑病,其中1例发生再次出血行内镜下套扎治疗;肝移植组术后恢复较好;再次行断流手术组,1例病人因出血无法控制死亡。结论对门静脉高压断流术后再出血的病人以上方法均有效,其中最有效的治疗方法是肝移植,对肝衰竭以及顽固性食管胃底静脉曲张上消化道出血的病人疗效好;肝功能较好且无肝性脑病者,或断流术后效果欠佳反复消化道出血病人可考虑行TIPS术;肝功能较差者,或病人急性消化道大出血身体状况较差者可选择内镜下套扎止血;再次手术难度大,风险高,再次行断流手术需慎重。

Objective To discuss and analyze the treatment of the recurrent upper gastrointesti- nal bleeding in portal hypertension patients after pericardial devascularization. Methods The clinical data of 60 patients with portal hypertension and recurrent upper gastrointestinal bleeding after pericar- dial devascularization were analyzed retrospectively from January 2013 to June 2015 in Department of General Surgery. Of the 60 patients, 25 were treated by endoscopic variceal ligation, 20 by transjugu- lar intrahepatic portosystemic shunt, 10 by liver transplantation, and 5 patients with serious esophage- al varices were given by reoperation. Results Eight cases in endoscopic variceal ligation group was subjected to the second ligature for re-bleeding, and there was 1 death due to massive hemorrhage. Two patients in TIPS group had hepatic encephalopathy and I of them was treated by endoscopic variceal ligation for re-hemorrhage. The patients in liver transplantation group recovered well. There was one death in reoperation group due to un-controllable serious bleeding. Conclusions All of the a hove treatments were effective, and the most effective measures were liver transplantation. The pa tients who did not suffer from hepatic encephalopathy could be given TIPS. The patients with hepatic insufficiency could choose endoscopic variceal ligation. The reoperation is difficult.