内镜下曲张静脉套扎术联合经颈静脉肝内门体静脉分流术治疗肝硬化食管胃底静脉曲张破裂出血患者效果研究

Efficacy of endoscopic variceal ligation and transjugular intrahepatic portal vein shunt in the treatment of patients with liver cirrhosis and complicated esophagogastric variceal bleeding

目的观察采用内镜下曲张静脉套扎术(EVL)联合经颈静脉肝内门体静脉分流术(TIPS)治疗肝硬化并发食管胃底静脉曲张破裂出血(EVB)患者的效果。方法2019年3月~2022年1月我院收治的85例肝硬化并发EVB患者,其中42例对照组接受EVL术治疗,43例观察组在接受EVL治疗后择期行TIPS治疗。随访6个月。采用超声检测门静脉压力梯度(PPG)、门静脉压力(PVP)和门静脉血流速度(PVFV),采用ELISA法检测血清过氧化脂质(LPO)、胃动素(MTL)和胃泌素(GAS)水平。结果急性期,观察组和对照组病死率分别为9.3%和9.5%(P>0.05);两组止血时间和输血量无显著性差异(P>0.05),而观察组住院日为(12.8±2.6)d,显著长于对照组【(8.1±1.5)d,P<0.05】;术后,观察组PVFV为(16.7±3.8)cm/s,显著快于对照组【(12.5±2.4),P<0.05】,而PPG和PVP分别为(9.1±1.4)mmHg和(19.6±2.3)mmHg,均显著低于对照组【分别为(12.2±1.9)mmHg和(34.8±3.4)mmHg,P<0.05】;观察组血清LPO、MTL和GAS水平分别为(4.1±2.2)U/L、(202.4±22.7)ng/L和(76.3±8.4)μg/mL,均显著低于对照组【分别为(7.9±1.6)U/L、(256.8±26.1)ng/L和(115.6±10.9)μg/mL,P<0.05】;随访6个月,对照组和观察组再出血发生率分别为31.6%和7.7%(P<0.05)。结论在实施EVL急性期止血后适时进行TIPS术治疗肝硬化并发EVB患者效果确切,可减少再出血发生率,值得进一步研究。

Objective This clinical trial was conducted to investigate the efficacy of endoscopic variceal ligation(EVL)and transjugular intrahepatic portal vein shunt(TIPS)in the treatment of patients with liver cirrhosis(LC)and complicated esophagogastric variceal bleeding(EVB).Methods 85 patients with LC and complicated EVB were enrolled in this study between March 2019 and January 2022,and 42 patients in control group received EVL and 43 patients in observation group received TIPS after EVL.All patients were followed-up for 6 months.The portal vein pressure gradient(PPG),portal vein pressure(PVP)and portal vein flow velocity(PVFV)were detected by ultrasonography,and serum lipid peroxide(LPO),motilin(MTL)and gastrin(GAS)levels were determined by ELISA.Results The fatality rates after first bleeding were 9.3%and 9.5%(P>0.05)in the observation and control groups;there was no significant differences as respect to the hemostasis time and blood transfusion volume between the two groups(P>0.05),while the hospital stay in the observation group was(12.8±2.6)d,much longer than[(8.1±1.5)d,P<0.05]in the control;one month after operation,the PVFV in the observation group was(16.7±3.8)cm/s,much faster than[(12.5±2.4),P<0.05],while the PPG and PVP were(9.1±1.4)mmHg and(19.6±2.3)mmHg,both significantly lower than[(12.2±1.9)mmHg and(34.8±3.4)mmHg,respectively,P<0.05]in the control;serum LPO,MTL and GAS levels in the observation were(4.1±2.2)U/L,(202.4±22.7)ng/L and(76.3±8.4)μg/mL,all much lower than[(7.9±1.6)U/L,(256.8±26.1)ng/L and(115.6±10.9)μg/mL,respectively,P<0.05]in the control;at the end of six-month follow-up,the incidence of re-bleeding in the observation groups was 7.7%,much lower than 31.6%(P<0.05)in the control.Conclusion The patients with decompensated LC receive TIPS after EVL is efficacious in preventing re-bleeding after first EVB,which is worthy of further investigation.