摘要
目的评价经颈静脉肝内门体支架分流术(TIPS)治疗胃底静脉曲张破裂出血的远期疗效。方法2014年1月至2016年1月,安徽医科大学第一附属医院65例肝硬化合并IGVl型胃静脉曲张破裂出血病例纳入回顾性分析,其中TIPS治疗者28例(TIPS组)、内镜下组织胶注射术(GVO)治疗者37例(GVO组),对比分析2组的远期随访结果。结果2组手术均成功,术后并发症总体发生率TIPS组和GVO组分别为7.14%(2/28)和13.51%(5/37),2组差异无统计学意义(P=0.801);TIPS组有9例(32.14%)发生肝性脑病(病情均较轻),GVO组未发生。TIPS组平均随访(20.18±6.90)个月,2例(7.14%)死亡,6个月、12个月、18个月时累积未出血率分别为88.4%、83.7%、76.1%;GVO组平均随访(16.14±6.03)个月,5例(13.51%)死亡,6个月、12个月、18个月累积未出血率分别为86.5%、70.2%、60.9%。2组随访期死亡率比较差异无统计学意义(P=0.690),18个月累积未出血率比较差异有统计学意义(log-rank检验,χ^2=6.304,P=0.012)。结论在控制胃底静脉曲张破裂出血方面,TIPS远期疗效优于GVO,但应警惕术后肝性脑病的发生。
Objective To evaluate the long-term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for gastric variceal bleeding. Methods A retrospective analysis was performed on the data of 65 cirrhotic patients with type 1 isolated gastric variceal bleeding in the First Affiliated Hospital of Anhui Medical University from January 2014 to January 2016. Patients were divided into two groups, TIPS treatment group (n = 28), and gastric variceal obturation (GVO) treatment group (n = 37). The long-term follow-up results of the two groups were compared. Results Operations of the two groups were succeed. Postoperative complications in the TIPS group and GVO group were 7.14% (2/28) and 13.51% (5/37) , respectively, (P= 0. 801 ). Nine cases (32. 14% ) had mild hepatic encephalopathy in the TIPS group, and no occurred in the GVO group. During the 20. 18±6.90 months of follow-up in the TIPS treatment group, 2 (7.14%) patients died, and the cumulative rebleeding-free rate at 6, 12 and 18 months was 88.4%, 83.7% and 76. 1%, respectively. During the 16. 14±6. 03 months of follow-up in the GVO treatment group, 5 ( 13.51% ) patients died, and the cumulative rebleeding-free rate at 6, 12 and 18 months was 86. 5%, 70. 2% and 60. 9%, respectively. The survival rate between the two groups had no significant difference (P= 0. 690). There was a statistically significant difference in the cumulative non-bleeding rate in 18 months of follow up( log-rank test, χ^2= 6. 304, P= 0. 012). Conclusion TIPS is superior to GVO for controlling gastric variceal bleeding in the long run, but clinicians should be vigilant to the occurrence of hepatic encephalopathy after operation.
作者
关玉龙
孔德润
张乐
李晶
Guan Yulong;Kong Derun;Zhang Le;Li Jing(Department of Gastroenterology,the First Affiliated Hospital of Anhui Medical University,Hefei230022,China;不详)
出处
《中华消化内镜杂志》
CSCD
北大核心
2018年第2期105-109,共5页
Chinese Journal of Digestive Endoscopy
基金
国家自然科学基金(81271736)
关键词
肝硬化
高血压
门静脉
颈静脉肝内门体支架分流术
内镜下组织胶注射术
Liver cirrhosis
Hypertension, portal
Transjugular intrahepatic portosystemic shunt
Endoscopic gastric variceal obturation
