TIPS治疗肝硬化食管胃底静脉曲张破裂出血的疗效及安全性研究

目的:研究经颈静脉肝内门体分流术(TIPS)治疗肝硬化食管胃底静脉曲张破裂出血的疗效及安全性。方法:选取我院2013年8月到2015年4月收治的肝硬化食管胃底静脉曲张破裂出血患者86例为研究对象,采用随机数字法将其分为对照组和观察组,每组各43例。对照组患者行经皮经肝胃冠状静脉栓塞术(PTVE)治疗,观察组患者行TIPS治疗。比较两组患者的手术成功率、各并发症发生率、远期生存率及症状缓解情况,同时观察两组患者术后的肝功能变化。结果:观察组手术后的门静脉压力、术后3个月、6个月及12个月再出血发生率均明显低于对照组(P0.05),而肝性脑病发生率与对照组比较差异无明显统计学意义(P0.05)。两组手术前、术后6个月和12个月的Child-Pugh评分、血清TBIL、DBIL水平比较均无明显差异(P0.05),术后3个月,观察组的Child-Pugh评分、血清TBIL、DBIL水平均明显高于对照组(P0.01)。两组术后1年生存率比较无明显差异(P=0.72)。结论:TIPS治疗肝硬化食管胃底静脉曲张破裂出血的手术安全性较高,术后再出血等并发症发生率低,能有效改善静脉曲张症状,对肝功能损伤控制较好,且远期生存率较高。

Clinical Effect and Safety of TIPS in Treatment of Esophageal and Gastric Varices Bleeding in Patients with Cirrhosis

ABSTRACT Objective: To study the clinical effect and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of liver cirrhosis with esophageal variceal bleeding. Methods: 86 cases of cirrhotic patients with esophageal and gastric varices bleeding admitted in our hospital from August 2013 to April 2015 were selected and randomly divided into the control group and the observation group with 43 cases in each group. The control group underwent percutaneous transhepatic coronary vein embolization (PTVE) treatment, while the observation group were treated with TIPS. The success rate of surgery, the incidence of various complications, the long-term survival rate and the symptoms and the changes of liver function after operation were compared between the two groups of patients. Results: The portal vein pressure after operation in the observation group was significantly lower than that of the control group (P=0.00), at 3 months, 6 months and 12 months after operation, the rebleeding rate in the observation group were significantly lower than that of the control group (P<0.05), but the incidence of hepatic encephalopathy showed no significant difference between the two groups (P>0.05); before operation and at 6 months and 12 months after operation, the Child-Pugh score, serum TBIL, DBIL levels showed no significant difference between the two groups(P>0.05), at 3 months after operation, the Child-Pugh score, serum TBIL, DBIL levels in the observation group were significantly higher than those of the control group(P<0.01); the 1 year survival rate showed no significant difference between two groups(P=0.72). Conclusion: TIPS could effectively improve the symptoms of varicose veins, better on liver function damage, and enhance the long-term survival high rate with high safely in the treatment of esophageal variceal bleeding in patients with cirrhosis.