摘要
目的探讨经颈静脉肝内门体分流术(TIPS)治疗肝硬化并发上消化道出血的临床疗效。方法收集2012年3月—2017年3月我院接受治疗的肝硬化并发上消化道出血患者110例,对照组(35例)接受常规内科保守治疗,TIPS组(75例)在对照组治疗基础上联合TIPS治疗。对比TIPS组患者手术前后门静脉压力、门静脉内径、门静脉流速、血小板计数(PLT)、红细胞计数(RBC)、白蛋白(ALB)、总胆红素(TBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)指标。随访并比较2组患者治疗后生存率、再出血率、生活质量情况。结果 75例行TIPS全部成功,技术成功率100%,围手术期无患者死亡,未出现心脏压塞、腹腔积血、胆汁瘘等严重并发症。与术前相比,TIPS术后门静脉压力、门静脉内径显著降低,门静脉流速明显加快(P<0.05)。随访期间共有11例患者死亡,病死率14.7%,TIPS分流道3、6、12、24、36个月累积原发通畅率分别为95.6%、90.1%、85.7%、79.0%、74.2%。术后6个月时,PLT、RBC、ALB较术前改善(P<0.05),而TBIL、ALT、AST与术前差异无统计学意义(P> 0.05)。对照组3、6、12、24、36个月累积生存率为94.3%、91.3%、75.8%、71.0%、59.2%,TIPS组分别为98.7%、97.3%、95.7%、83.4%、70.6%,2组差异无统计学意义(Log-rankχ2=2.743,P=0.098)。对照组3、6、12、24、36个月累积再出血率为5.7%、17.1%、23.5%、31.9%、43.2%,TIPS组分别为2.7%、4.0%、8.3%、14.4%、24.0%,2组差异具有统计学意义(Log-rankχ2=4.608,P=0.032)。与对照组比较,TIPS组术后6个月生活质量各项指标均明显改善,差异有统计学意义(P<0.05)。结论 TIPS治疗肝硬化并发上消化道出血是安全、有效的,与保守治疗相比,TIPS可显著降低再出血率,并改善患者生存质量。
Objective To explore the clinical efficacy of transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of upper gastrointestinal bleeding in patients with hepatocirrhosis.Methods Totally 75 hepatocirrhosis patients with upper gastrointestinal bleeding accepted TIPS treatment in our institution from March 2012-March 2017 were collected retrospectively in this study.Patients were divided into two groups,the control group(n=35)underwent conservative treatment,and the TIPS group(n=75)received TIPS treatment on the basis of conservative therapy.Indexes of portal venous pressure,portal vein diameter,portal velocity,platelet count(PLT),erythrocyte count(RBC),albumin(ALB),total bilirubin(TBIL),glutamic-pyruvic transaminase(ALT),and glutamic-oxalacetic transaminase(AST)before and after operation were compared between two groups.Data of survival rate,rehaemorrhage rate and living quality after the operation were followed up,and which were compared between the two groups.Results Totally 75 patients received TIPS and were all successful,with the technical success rate 100%.There were no patients died during the perioperative period.No serious complications such as cardiac tamponade,hematocelia and biliary fistula were found.Compared with pre-operation,portal venous pressure and portal vein diameter were significantly decreased,and portal velocity was increased after operation(P<0.05).Totally 11 patients were dead during the follow-up period,with fatality rate 14.7%.Original unobstructed rate of TIPS runner at 3,6,12,24 and 36 months were 95.6%,90.1%,85.7%,79.0%,and 74.2%respectively.Compared with pre-operation,indexes of PLT,RBC and ALB at 6 months after surgery were improved(P<0.05).Whereas there were no significant differences in TBIL,ALT and AST before and after operation(P>0.05).There were no significant differences in accumulate survival rates at 3,6,12,24 and 36 months between control group(94.3%,91.3%,75.8%,71.0%,and 59.2%respectively)and TIPS group(98.7%,97.3%,95.7%,83.4%,and 70.6%respectively,Log-rankχ2=2.743,P=0.098).Accumulate rehaemorrhage rates at 3,6,12,24,and 36 months were 5.7%,17.1%,23.5%,31.9%,and 43.2%respectively in the control group,and they were 2.7%,4.0%,8.3%,14.4%,and 24.0%respectively in the TIPS group.There were significant differences in accumulate rehaemorrhage rates between the two groups(Log-rankχ2=4.608,P=0.032).Compared with control group,indicators of living quality were improved at 6 months after surgery in the TIPS group(P<0.05).Conclusion TIPS is safe and effective for cirrhosis patients with upper gastrointestinal bleeding.Compared with conservative treatment,TIPS can decrease rehaemorrhage rate and improve living quality of patients.
作者
张庆贤
黄金旗
陈煌
ZHANG Qing-xian;HUANG Jin-qi;CHEN Huang(Department of Intervention and Vascular Surgery,the First Hospital of Putian City,Putian 351100,China)
出处
《天津医药》
CAS
北大核心
2018年第9期967-972,共6页
Tianjin Medical Journal
关键词
肝硬化
高血压
门静脉
胃肠出血
门体分流术
经颈静脉肝内
liver cirrhosis
hypertension,portal
gastrointestinal hemorrhage
portasystemic shunt,transjugular intrahepatic
