摘要
目的:探讨急诊行经颈静脉肝内门体分流术(TIPS)治疗门静脉高压症急性上消化道出血的可行性、有效性及安全性,评估其临床应用价值。方法:选择2015-04—2017-03期间潍坊市人民医院收治的肝硬化门脉高压症合并上消化道出血的患者共78例,使用随机数字表法将病例随机分为观察组及对照组,每组39例。观察组接受TIPS手术治疗,对照组行脾切除、贲门周围血管离断术。随访1年,观察并比较两组手术前后的血流动力学指标、肝功能、凝血功能指标,比较两组患者术后1年内再出血率、围手术期及术后并发症发生率。结果:两组患者均顺利接受相应手术,观察组无围手术期死亡病例,对照组围手术期死亡1例,为术后门静脉血栓形成导致小肠大面积坏死;观察组患者较对照组术后门静脉内径(PVD)显著变细,门静脉压力(PVP)明显下降,门静脉血流量(PVF)明显减少,而门静脉流速(PVV)较对照组明显加快,差异均具有统计学意义(P<0.05);观察组术后AST、ALT、TBIL水平均低于对照组(P<0.05),而PT、APTT指标较对照组差异无统计学意义(P>0.05)。观察组术后1年内再出血病例3例,分别为术后第4、6、11个月出现再出血,其中1例行内镜下套扎术,另2例行内科保守治疗后治愈;6例患者术后1年内出现Ⅱ级以上的肝性脑病,2例患者出现肝功能衰竭而死亡,分别为术后第3、8个月。对照组术后1年内再出血病例2例,分别为术后2、5个月,均行内镜下套扎术后治愈;5例患者术后1年内出现Ⅱ级以上的肝性脑病,1例患者出现肝功能衰竭而死亡,为术后第5个月。两组在术后1年内再出血率、围手术期及术后并发症发生率比较,差异均无统计学意义(P>0.05)。结论:TIPS可明显改善患者的血流动力学指标及肝功能,治疗门静脉高压症上消化道出血与传统手术方式相比,创伤小,效果显著,安全性高,值得临床进一步推广应用。
Objective:To investigate the feasibility,efficacy,and safety of transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of acute upper gastrointestinal bleeding induced by portal hypertension and evaluate its clinical application value.Method:Seventy-eight patients with the diagnosis of upper gastrointestinal bleeding induced by cirrhotic portal hypertension in the Weifang People’s Hospital from April 2015 to March 2017 were included.The patients were randomized divided into the observation group and the control group by using the random number table,with 39 cases in each group.The observation group received TIPS surgery,while the control group underwent splenectomy and pericardial devascularization.Follow up for 1 year,the preoperative and postoperative hemodynamic indexes,liver function and coagulation function indexes of the two groups were compared.The rebleeding rate within 1 year after operation,and the perioperative and postoperative complication rates were compared between the two groups.Result:The patients in both groups received the corresponding operation.There was no perioperative death in the observation group,1 patient of the control group died because of massive necrosis of the small intestine induced by portal vein thrombosis.The portal vein diameter(PVD)of the observation group was significantly smaller than that of the control group,the portal vein pressure(PVP)and the portal venous blood flow were significantly decreased compared with the control group(P<0.05).and the portal vein velocity(PVV)was significantly faster than that of the control group(P<0.05).The levels of AST,ALT and TBIL in the observation group were lower than those in the control group(P<0.05),while the PT and APTT in the observation group were not significantly different from those in the control group(P>0.05).In the observation group,rebleeding occurred in 3 patients,respectively in the 4,6,11 months after operation.1 patient was cured by endoscopic ligation and the other 2 patients were cured by conservative tr
作者
马永彪
林丽
丁伟
赵学林
王玉许
MA Yongbiao;LIN Li;DING Wei;ZHAO Xuelin;WANG Yuru(Department of Hepatobiliary Surgery,Weifang People's Hospital,Weifang,Shandong,261041,China)
出处
《临床急诊杂志》
CAS
2020年第10期783-788,共6页
Journal of Clinical Emergency
基金
潍坊市卫生计生委科研计划项目(No:2016wsjs004)。
关键词
肝硬化
门静脉高压症
经颈静脉肝内门体分流术
血流动力学
消化道出血
cirrhosis
portal hypertension
transjugular intrahepatic portosystemic shunt
hemodynamics
gastrointestinal bleeding
