Child C级肝硬化门脉高压症食道胃底静脉破裂出血的治疗

The treatment for acute variceal hemorrhage of patients with Child class C cirrhosis

目的 探讨 Ｃｈｉｌｄ Ｃ级肝硬化门脉高压症食道胃底静脉破裂出血病人的安全有效的治疗方案。方法 对 １０９例急性大出血人院的 Ｃｈｉｌｄ Ｃ级肝硬化门脉高压症病人的治疗结果进行回顾性分析，对外科手术（２９例）、内科治疗（６１例）和ＴＩＰＳＳ（１９ 例）三种治疗方法的疗效、并发症和死亡率进行对比。结果 急诊手术、内科治疗、ＴＩＰＳＳ的住院死亡率分别为６５．５％、３６．１％和２６．３％；住院期间再出血率分别为 ２４．ｌ％、３６．ｌ％、１５．８％。随访期的再出血率分别为 ３３．０％、３６．ｌ％和 ２１．４％。住院死亡率手术组显著高于另外两组（Ｐ＜０．０１）。ＴＩＰＳＳ组的住院再出血率及随访期再出血率显著低于内科组（Ｐ＜０．０５和Ｐ＜０．０１）。三组病人的生存率无显著性差异（Ｋａｐｌａｎ－Ｍｅｉｅｒ分析，Ｐ＝０．０７＞０．０５）。结论ＴＩＰＳＳ作为一种微创介入技术是一种挽救 Ｃｈｉｌｄ Ｃ级门脉高压症食管静脉破裂出血病人生命的有效方法。其止血效果不亚于手术治疗，死亡率低于手术治疗，而再出血率低于内科治疗。更长期的疗效尚待进一步研究。

Objective To seek an effective and safe therapy for acute variceal hemorrhage of patients with Child class C cirrhosis. Methods One hundred and nine Child class C cirrhotic patients with an acute hemorrhage from esophageal varices were reviewed. Sixty - one patients received medical therapy;29 patients were underwent sur- gical operations and 19 patients received TIPSS. Results The surgical group had a higher mortality rate during hos- pitalization(65. 5 % ) than either of the other groups(36. 1 % and 26. 3 % respectively ). The rebleeding rates during hospitalization were 24. 1 %, 36. 1 % and 15. 8 % respectively in the surgical group, medical group and TIPSS group. Rebleeding rate during following- up period were 33. 0%, 36. 1 % and 21 .4% respectively. The rebleeding rate was significantly higher in the medical group than that in either of the other groups during the two phases. Kaplan - Meier survival analysis didn' t show significant difference among the three groups. Conclusions The results showed that TIPSS is a good alternative to surgical or medical therapy for patients with Child class C cirrhosis and acute vericeal bleeding.