天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (5): 529-534.doi: 10.11958/20160136

• 专题研究-消化疾病 • 上一篇    下一篇

TIPS 和 PTVE 治疗肝硬化食管胃底静脉曲张破裂出血的 临床效果比较

羊丹 1， 张国梁 2△， 王凤梅 3△， 边芬 1， 贾科峰 4   

  1. 1天津医科大学一中心临床学院 （邮编 300192）， 2消化内科； 3天津市第三中心医院消化 （肝病） 科， 4放射科
  • 收稿日期:2016-03-09 修回日期:2016-04-15 出版日期:2016-05-15 发布日期:2016-05-18
  • 通讯作者: △通讯作者 E-mail： zgl_022@sina.com； wangfengmeitj@126.com E-mail:lingluohuawu@163.com
  • 作者简介:羊丹 （1989）， 女， 硕士在读， 主要从事肝脏病基础与临床研究、 消化内镜相关研究

Comparison of the efficacy transjugular intrahepatic portosystemic shunt and percutaneous transhepatic variceal embolization for cirrhosis with esophageal gastric varices bleeding

YANG Dan1, ZHANG Guoliang2△, WANG Fengmei3△, BIAN Fen1, JIA Kefeng4   

  1. 1 Department of Gastroenterology, 2 Department of Gastroenterology, the First Central Clinical College, Tianjin Medical University, Tianjin 300192, China；3 Department of Gastroenterology and Hepatology, 4 Department of Radiology, the Third Central Hospital
  • Received:2016-03-09 Revised:2016-04-15 Published:2016-05-15 Online:2016-05-18
  • Contact: △Corresponding Author E-mail： zgl_022@sina.com； wangfengmeitj@126.com E-mail:lingluohuawu@163.com

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摘要： 摘要： 目的 探讨经颈静脉肝内门体分流术 （TIPS） 和经皮经肝胃冠状静脉栓塞术 （PTVE） 对肝硬化食管胃底静 脉曲张破裂出血的疗效。方法 回顾性分析因肝硬化食管胃底静脉曲张破裂出血就诊并实施介入治疗的 61 例患 者资料， 其中 PTVE 组 42 例， TIPS 组 19 例。比较 2 组治疗成功率、 再出血率、 曲张静脉缓解情况、 肝性脑病发生率、 生存率及肝功能变化等。结果 2 组手术均成功， TIPS 组术后门静脉压力明显下降， PTVE 组的再出血率为 78.6%， 高于 TIPS 组的 63.2%， PTVE 组术后食管胃底静脉曲张缓解的有效率为 50.0%， 明显低于 TIPS 组的 89.5%（均 P＜ 0.05）； PTVE 组和 TIPS 组肝性脑病发生率分别为 14.3%和 26.3%， 2 年累积生存率分别为 95.2%和 89.5%， 差异均无 统计学意义； PTVE 组术后各时期肝功变化与术前差异无统计学意义； TIPS 组术后 1、 3 个月肝功能较术前及 PTVE 术后同一时期下降， 术后 6、 12 个月肝功能变化与术前及 PTVE 术后同一时期相比差异无统计学意义。结论 TIPS 治疗肝硬化食管胃底静脉曲张破裂出血手术安全， 再出血率低， 食管胃底静脉曲张好转快， 术后中远期对肝功能影 响较小， 是一种理想的介入治疗方法。

关键词: 门体分流术, 经颈静脉肝内, 食管和胃底静脉曲张, 出血, 肝硬化, 肝性脑病, 经皮经肝胃冠状静脉栓塞 术, 再出血率, 肝功能

Abstract: Abstract：Objective To explore the clinical effect of transjugular intrahepatic portosystemic shunt (TIPS) and percutaneous transhepatic variceal embolization (PTVE) on the treatment of cirrhosis with esophageal gastric varices bleeding. Methods The data of 61 patients of liver cirrhosis combined with esophageal gastric varices bleeding who underwent the interventional treatment were included in the retrospective analysis. Patients were divided into two groups, PTVE treatment group (n=42), and TIPS treatment group (n=19). The success rate of clinical treatment, the rebleeding rate, the alleviation of varicose veins, the incidence of hepatic encephalopathy, survival rate and liver function parameters were compared between two groups. Results Two groups of surgery were successful. The portal vein pressure decreased obviously in TIPS group. The rebleeding rate was higher in PTVE group (78.6%) than that in TIPS group (63.2%). The total alleviation rate of esophageal gastric varices was significantly lower in PTVE group (50.0%) than that in TIPS group (89.5%, P＜0.05). The incidence rates of hepatic encephalopathy were 14.3% and 26.3% for PTVE group and TIPS group respectively. The two-year cumulative survival rates of PTVE group and TIPS group were 95.2% and 89.5% respectively, and there was no statistically significant difference between two groups. After surgery, the liver function parameters were not significantly different from those determined before the treatment in PTVE group. At 1 month and 3 months after TIPS, the liver functions were declined obviously. At 6 and 12 months after the treatment, the liver functions were not significantly different from those determined before the treatment in PTVE group. Conclusion The surgery of TIPS is safe and ideal interventional treatment for cirrhosis with esophageal gastric varices bleeding, which has the lower rebleeding rate, better esophageal gastric varices alleviation rate and long term less influence in liver function.

Key words: portasystemic shunt, transjugular intrahepatic, esophageal and gastric varices, hemorrhage, liver cirrhosis, hepatic encephalopathy, percutaneous transhepatic variceal embolization, rebleeding rate, liver function