摘要
目的评价经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)联合胃冠状静脉栓塞术治疗肝硬化伴食管、胃底静脉曲张出血的疗效及安全性,评估其应用价值。方法回顾性分析2009年6月—2013年1月行TIPS联合胃冠状静脉栓塞术的肝硬化伴食管、胃底静脉曲张出血的50例患者临床资料。根据Child-Pugh肝功能评分,将患者分成A、B、C级肝功能组,每组分别6、18、26例,同时根据植入支架的类型将患者分为覆膜支架组(29例)与裸支架组(21例),比较各组患者术前与术后1周及术后1、3、6、12个月的肝功能指标[谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TB)、直接胆红素(direct bilirubin,DB)、白蛋白(albumin,ALB)]变化,并于术后2年内观察患者再次出血、支架狭窄和肝性脑病发生情况。结果 50例患者手术成功率100.0%(50/50),3例食管胃底静脉曲张活动性出血患者急诊手术成功率100.0%(3/3)。50例患者门静脉主干压力由术前(39.46±2.82)cm H_2O(1 cm H_2O=0.098 k Pa)降为术后(25.62±2.13)cm H2O,差异有统计学意义(P<0.05)。A、B级肝功能组患者,覆膜支架和裸支架组患者术前与术后1周及1、3、6、12个月肝功能指标(ALT、AST、TB、DB、ALB)比较,差异均无统计学意义(P>0.05)。C级肝功能组患者术后1周和术后1、3个月的ALT、AST、TB、DB较术前升高,差异有统计学意义(P<0.05);而术后1周和术后1、3个月的ALB,及术后6、12个月肝功能指标(ALT、AST、TB、DB、ALB)与术前比较,差异均无统计学意义(P>0.05)。术后2年再次出血率为12.0%(6/50);术后2年肝性脑病发生率为16.0%(8/50);术后2年支架狭窄率为26.0%(13/50),其中覆膜支架组和裸支架组狭窄率分别为13.8%(4/29)和42.9%(9/21);术后2年患者生存率为90.0%(45/50)。结论 TIPS联合胃冠状静脉栓塞术治疗肝硬化伴食管、胃底静脉曲张出血有�
Objective To evaluate the efficacy and safety oftransjugular intrahepatic portosystemic shunt （TIPS） combined with gastric coronary vein embolization for the treatment of liver cirrhosis with gastroesophageal varices hemorrhage, and evaluate its application value. Methods The data of 50 patients with liver cirrhosis who were treated with TIPS combined with gastric coronary vein embolization between June 2009 and January 2013 were retrospectively analyzed. According to Child-Pugh Liver Grade, the patients were divided into grade A liver function group （n=6）, grade B liver function group （n=18）, and grade C liver function group （n=26）; according to the type of stent implantation,the patients were divided into covered stent group （n=29） and bare stent group （n=21）. The 1-week and 1-, 3-, 6-, and 12- month postoperative liver function changes were compared, and the 2-year postoperative rebleeding rate, survival rate, stent restenosis rate, and hepatic encephalopathy incidence were observed. Results The success rate of surgery was 100.0% （50/50）, and the success rate of emergency surgery was 100.0% （3/3） in 3 patients with active bleeding. The portal vein pressure decreased from （39.46±2.82） cm H20 （1 cm H2O=0.098 kPa） before the surgery to （25.62±2.13） cm H2O after the surgery, and the difference was statistically significant （P〈0.05）. In grade A and grade B liver function groups, and covered stent and bare stent groups, the differences between preoperative and postoperative liver function indexes were not statistically significant （P〉0.05）; in grade C liver function group, the 1-week, I-month, 3-month postoperative values of alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin increased compared with the preoperative values, and the differences were statistically significant （P〈0.05）. The postoperative 2-year rebleeding rate was 12.0% （6/50）, and the postoperative 2-year incidence of hepatic encephalopathy was 1
作者
姚勇
张春乐
徐建玉
刘天宇
刘杰
谢兰
YAO Yong ZHANG Chunle XU Jianyu LIU Tianyu LIU Jie XlE Lan(Department of Gastroenterology, Suining Central Hospital, Suining, Sichuan 629000, P. R. Chin)
出处
《华西医学》
CAS
2017年第8期1173-1178,共6页
West China Medical Journal
关键词
肝硬化
经颈静脉肝内门体分流术
胃冠状静脉栓塞术
肝性脑病
支架狭窄
Liver cirrhosis
Trans）ugular intrahepatic portosystemic shunt
Gastric coronary vein embolization
Hepatic encephalopathy
Stent stenosis
