TIPS联合GCVE用于门静脉高压并发上消化道大出血的应用价值

The application value of TIPS combined with GCVE in the treatment of portal hypertension complicated with massive upper gastrointestinal hemorrhage

目的研究经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)治疗门静脉高压并发上消化道大出血的临床价值。方法本院74例门静脉高压上消化道大出血患者作为研究对象,其中37例行TIPS联合GCVE,为观察组。另37例行脾切除+贲门周围血管离断术治疗,为对照组。比较两组术后并发症,比较两组手术前后国际标准化比值(INR)、血清白蛋白、总胆红素(TBIL)、纤维蛋白原(Fib)水平。记录术后血栓情况和1年再出血率。结果两组术后白蛋白、INR、TBIL及Fib水平无显著性差异(P>0.05)。两组术后腹水、术后疼痛、切口感染及肺部感染发生率差异无统计学意义(P>0.05)。两组间术后肝性脑病与术后1年再出血发生率差异显著(P<0.05)。观察组不同肝功能分级患者术后肝性脑病发生率差异有统计学意义(P<0.05)。结论 TIPS联合GCVE与脾切除+贲门周围血管离断术治疗门静脉高压上消化道大出血疗效相近,TIPS联合GCVE术后再出血率更低,但可能增加肝性脑病风险。

Objective To study the clinical value of transjugular intrahepatic portosystemic shunt(TIPS)and gastric coronary vein embolization(GCVE)in the treatment of portal hypertension with massive upper gastrointestinal hemorrhage.Methods Seventy-four patients with portal hypertension and massive upper gastrointestinal hemorrhage in our hospital were selected as study subjects.There were 37 cases undergoing TIPS and GCVE in the observation group,and 37 cases treated with splenectomy and pericardial devascularization in the control group.The postoperative complications were compared between the 2 groups.The international normalized ratio(INR),serum albumin,total bilirubin(TBIL)and fibrinogen(Fib)levels before and after operation were compared between the 2 groups.The postoperative thrombosis and 1-year rebleeding rate were recorded.Results There were no significant differences in the levels of albumin,INR,TBIL and Fib between the 2 groups(P>0.05).There were no significant differences in the incidences of postoperative ascites,postoperative pain,incision infection and lung infection between the 2 groups(P>0.05).There were significant differences in the incidence of postoperative hepatic encephalopathy and 1-year rebleeding rate between the 2 groups(P<0.05).In the observation group,there was significant difference in the incidence of hepatic encephalopathy among patients with different liver function grades after operation(P<0.05).Conclusion The TIPS combined with GCVE has similar efficacy to splenectomy plus pericardial devascularization in the treatment of portal hypertension with massive upper gastrointestinal hemorrhage.The 1-year rebleeding rate after TIPS combined with GCVE is lower,but the risk of postoperative hepatic encephalopathy is higher.