TIPS联合GCVE治疗肝硬化门静脉高压症伴上消化道出血的效果评价

Assessment on the Effect of TIPS Combined with GCVE for the Treatment of Cirrhotic Portal Hypertension Complicated with Upper Gastrointestinal Hemorrhage

目的观察经颈静脉肝内门体静脉分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)治疗肝硬化门静脉高压症伴上消化道出血患者的临床疗效。方法选择2013年7月至2016年7月我院收治的肝硬化门脉高压症伴上消化道出血患者60例,随机分为对照组(单纯TIPS治疗)和观察组(TIPS联合GCVE治疗),每组各30例。比较两组术后1年的治疗效果、肝功能变化和不良反应发生率。结果术后1年,观察组的再出血率、肝性脑病发生率、分流道通畅率及生存率均显著优于对照组(P<0.05)。两组患者手术前后的肝功能变化无统计学差异(P>0.05);两组患者的术后并发症发生率比较无统计学差异(P>0.05)。结论 TIPS联合GCVE治疗肝硬化门静脉高压症伴上消化道出血患者能在稳定肝功能的情况下,降低1年再出血率及肝性脑病发生率,提高分流道通畅率及生存率,其疗效优于单纯TIPS治疗。

Objective To observe the clinical effect of transjugular intrahepatic portosystemic shunt （TIPS） combined with gastric coronary vein embolization （GCVE） for the treatment of patients with cirrhotic portal hypertension complicated with upper gastrointestinal hemorrhage. Methods 60 cases of patients with cirrhotic portal hypertension complicated with upper gastrointestinal hemorrhage admitted to our hospital from July 2013 to July 2016 were selected and randomly divided into the control group （TIPS） and the observation group （TIPS ＋ GCVE）, with 30 cases in each group. The efficacy at 1 year after surgery, liver function changes and incidence of adverse reactions were compared between two groups. Results 1 year after surgery, the re-bleeding rate, incidence of hepatic encephalopathy, shunt patency rate and survival rate of observation group were significantly better than those of control group （P〈0.05）. Before and after surgery, both groups had no significant change in the liver function （P〉0.05）. No statistical difference was found between two groups in the incidence of postoperative complications （P〉0.05）. Conclusions TIPS combined with GCVE for the treatment of patients with cirrhotic portal hypertension complicated with upper gastrointestinal hemorrhage can reduce the 1-year re-bleeding rate and incidence of hepatic encephalopathy, and improve the shunt patency rate and survival rate in the case of stable liver function. TIPS combined with GCVE has better efficacy than TIPS.