PTVE 与TIPS治疗肝硬化门静脉高压合并食管胃底静脉曲张破裂出血 的疗效比较

目的:研究经皮胃底曲张静脉栓塞术(PTVE)和经颈静脉肝内门体分流术(TIPS)治疗肝硬化门静脉高压合并食管胃底静脉曲张破裂出血的临床疗效,为临床治疗提供依据。方法:选取2001年4月到2015年4月我院肝硬化门静脉高压合并食管胃底静脉曲张破裂患者169例,根据手术方式分为PTVE组(行PTVE治疗)141例和TIPS组(行TIPS治疗)28例,比较两组术前、术后门静脉压力,术前、术后3个月、6个月以及1年两组Child-Pugh评分、白蛋白以及直接胆红素,并比较两组再出血和肝性脑病发生率。结果:TIPS组术后门静脉压力较术前显著降低,比较差异具有统计学意义(P0.05),术后PTVE组及TIPS组组间比较差异具有统计学意义(P0.05);两组术前和术后各时间直接胆红素无统计学意义(P0.05);PTVE组术后1年白蛋白水平显著升高,与术前和TIPS组比较差异具有统计学意义(P0.05),TIPS组术后白蛋白有所升高,但各时间比较差异无统计学意义(P0.05),PTVE组术后各时间Child-Pugh评分较术前明显改善,比较差异具有统计学意义(P0.05),TIPS组术后3个月和术后6个月Child-Pugh评分较术前明显改善,比较差异具有统计学意义(P0.05);两组术后再出血发生率比较无统计学意义(P0.05),PTVE组肝性脑病发生率显著低于TIPS组,比较差异具有统计学意义(P0.05)。结论:PTVE和TIPS治疗肝硬化门静脉高压合并食管胃底静脉曲张破裂出血效果相当,TIPS能显著降低门静脉压,PTVE能降低肝性脑病的发生率,改善患者Child-Pugh评分。

Cirrhotic Portal Hypertension Combined with Esophageal Gastric Varices Bleeding: Comparison of Efficacy of PTVE and TIPS

Objective:To study the efficacy of percutaneous transhepatic varices embolization (PTVE) and transjugular intrahepatic portasystemic shunt (TIPS) in treatment of cirrhotic portal hypertension combined with esophageal gastric varices bleeding, and to provide the basis for clinical treatment.Methods:A total of 169 patients with cirrhosis portal hypertension combined with esophageal gastric varices bleeding, who were admitted to The first clinical college of Tianjin Medical University from April 2001 to April 2015, were selected and divided into PTVE group(treated with PTVE) with 141 patients and TIPS group(treated with TIPS) with 28 patients according to the operation mode. The portal pressure before and after operation, the Child-Pugh score, albumin and direct bilirubin before operation, 3 months, 6 months and 1 year after operation of the two groups, and the incidence of recurrent hemorrhage and hepatic encephalopathy between the two groups were compared.Results:The portal pressure of TIPS group significantly decreased compared with before operation, the difference was statistically significant (P<0.05); the differences after operation between PTVE and TIPS groups were statistically significant (P<0.05). The differences of the direct bilirubin before and after operation had no significance (P>0.05). The level of albumin in PTVE group significantly increased 1 year after operation, the difference was statistically significant compared with before operation and TIPS group (P<0.05); the level of albumin in TIPS group increased after operation, but there was no significance between each time(P>0.05). The Child-Pugh score after operation of PTVE group was significantly improved compared with before operation, the difference was statistically significant (P<0.05); the Child-Pugh scores in TIPS group 3 months and 6 months after operation were significantly improved compared with before operation, the differences were statistically significant (P<0.05). The incidence of recurrent hemorrhage of two groups after operation had no significance(P>0.05). The incidence of hepatic encephalopathy in PTVE group was significantly lower than that in TIPS group, the difference was statistically significant (P<0.05).Conclusion:PTVE and TIPS in the treatment of cirrhosis portal hypertension complicated with esophageal gastric varices bleeding had better effects. TIPS can significantly reduce portal pressure; PTVE can reduce the incidence of hepatic encephalopathy, and improve Child-Pugh scores of the patients.