TIPS联合胃冠状静脉栓塞治疗肝硬化门静脉高压伴上消化道出血

摘要

Objective To compare the clinical curative effect between transjugular intrahepatic portosystemic stent-shunt (TIPS) and TIPS together with gastric coronary vein embolization (GCVE) in treating cirrhosis portal hypertension (PHT) associated with upper gastrointestinal hemorrhage (UGH),and to discuss the necessity,feasibility and clinical curative effect of TIPS plus GCVE.Methods The clinical data of 38 PHT patients with UGH,who were admitted to authors' hospital during the period from April 2010 to May 2012,were retrospectively analyzed.Only TIPS was employed in 15 patients (group A),and TIPS plus GCVE was adopted in 23 patients (group B).Before and after operation,the indexes,hemodynamics of portal vein and spleen,the morphology of spleen,and the degree of gastrointestinal varices were determined and analyzed.The patients were followed up to observe the occurrence of postoperative complications.Results In both groups,the postoperative portal vein pressure showed an obvious reduction with accelerated velocity of flow,and the splenic venous congestion index was decreased,these changes were statistically significant when compared with the preoperative ones (P＜0.05),and which was more obvious in group B than in group A (P＜0.05).After the treatment,the esophagogastric varices (EGV) was obviously improved,the improvement rates of group B and group A were 94.7％ and 66.6％ respectively,the emergency hemostasis rates of group B and group A were 100％ and 75.0％ respectively,The rates of re-bleeding were 4.3％ and 28.5％ respectively;the above results of group B were statistically better than those of group A (P＜0.05).No statistically significant differences in liver function indexes existed between preoperative values and postoperative ones in the same group as well as in group comparison (P＞0.05).The differences in the postoperative hepatic encephalopathy (HE) occurrence and in primary patency rate of stent between the two groups were not statistically significant (P＞0.05).In both groups,the re-intervention patency rate was 100％.The incidence rate of HE in patients in whom the distal end of stent was located in the left branch of portal vein was strikingly lower than that in patients in whom the distal end of stent was located in the right branch of portal vein (P＜0.05).Conclusion For the treatment of PHT associated with UGH,TIPS combined with GCVE carries reliable curative effect,this therapy is superior to simple use of TIPS.%目的 对比单纯TIPS和TIPS联合胃冠状静脉栓塞术(GCVE)治疗肝硬化门静脉高压症(PHT)伴上消化道出血(UGH),分析TIPS和GCVE联合应用的必要性、可行性及临床疗效.方法 回顾性分析2010年4月至2012年5月收治的38例PHT伴UGH患者临床资料,其中接受单纯TIPS治疗15例(A组),TIPS联合GCVE治疗23例(B组),观察分析手术前后血液指标、门静脉及脾脏血流动力学、脾脏形态学、消化道静脉曲张程度变化.随访术后并发症发生情况.结果 两组术后门静脉压降低、流速加快、脾静脉淤血指数降低均较术前明显(P＜0.05),B组均优于A组(P＜0.05).术后两组食管胃底静脉曲张(EGV)均明显好转(P＜0.05),B组和A组EGV好转率分别为94.7％、66.6％,急诊止血率分别为100％、75％,再出血率分别为4.3％、28.5％,B组均明显优于A组(P＜0.05).手术前后肝功能指标组内、组间比较,差异均无统计学意义(P＞0.05).两组术后肝性脑病(HE)发生率、支架原发通畅率差异均无统计学意义(P＞0.05).两组再介入通畅率均为100％,支架远端位于门静脉左支者HE发生率显著低于位于右支者(P＜0.05).结论 TIPS联合GCVE治疗肝硬化PHT伴UGH疗效确切,优于单纯TIPS.