摘要
目的对比内镜下曲张静脉套扎术(EVL)和早期经颈静脉肝内门体分流术(TIPS)治疗肝硬化急性食管静脉曲张出血(EVB)的临床疗效。方法回顾性分析2014年1月至2016年12月住院行EVL或早期TIPS治疗且资料完整的肝硬化急性EVB患者48例,其中EVL组20例,早期TIPS组28例,对比二组患者一般资料、食管胃静脉曲张(GOV)转归、再出血率、生存率、并发症情况。结果二组患者一般资料差异均无统计学意义(P>0.05);早期TIPS组比EVL组GOV改善率高,差异有统计学意义(P<0.05),早期TIPS组比EVL组GOV无效率低,差异有统计学意义(P<0.05),二组治疗均有1例急性期止血失败,差异无统计学意义(P>0.05);早期TIPS组比EVL组未出血率高,差异有统计学意义(P<0.05);EVL组和早期TIPS组患者2 a累积再出血率差异有统计学意义(75.0%vs 39.3%,χ2=7.023,P=0.008,Log-rank检验);EVL组和早期TIPS组患者2 a累积生存率差异无统计学意义(85%vs 92.8%,χ2=0.766,P=0.381,Log-rank检验);早期TIPS组中肝性脑病发病率比EVL组高,差异有统计学意义(P<0.05)。结论EVL和早期TIPS均有较好的急性期止血效果,急性期止血两者治疗均可选择,早期TIPS极大缓解了GOV程度,预防远期再出血更具有优势,但并发肝性脑病概率较高,且不能显著改善患者生存率。
Objective To compare the clinical efficacy of endoscopic varicose vein ligation(EVL)and early intrajugular intrahepatic portal body shunt(TIPS)in the treatment of acute esophageal varicose bleeding(EVB)in cirrhosis.Methods A retrospective analysis was performed on 48 cases of acute EVB patients with cirrhosis who received EVL or early TIPS treatment in hospital from January 2014 to December 2016 with complete data,including 20 cases in the EVL group and 28 cases in the early TIPS group.The general data,esophagogastric varicose vein(GOV)outcome,rebleeding rate,survival rate and complications of the two groups were compared.Results There was no statistically significant difference in the general data between the two groups(P>0.05)GOV improvement rate in the early TIPS group was higher than that in the EVL group,and the difference was statistically significant(P<0.05).GOV inefficiency in the early TIPS group was lower than that in the EVL group,and the difference was statistically significant(P<0.05).The early TIPS group had a higher non-bleeding rate than the EVL group,and the difference was statistically significant(P<0.05).The 2-year cumulative rebleeding rate of patients in the EVL group and the early-stage TIPS group was statistically significant(75.0%vs 39.3%,chi-squareχ2=7.023,P=0.008,log-rank test).There was no statistically significant difference in 2-year cumulative survival between EVL group and early-stage TIPS group(85%vs 92.8%,chi-squareχ2=0.766,P=0.381,log-rank test).The incidence of hepatic encephalopathy in the early TIPS group was higher than that in the EVL group,and the difference was statistically significant(P<0.05).Conclusion Both EVL and early TIPS have good hemostasis effect in the acute phase,and both can be selected for treatment of acute phase hemostasis.Early TIPS greatly alleviates the extent of GOV,and has advantages in preventing long-term rebleeding,but the incidence of complicated hepatic encephalopathy is high,and the survival rate of patients cannot be significantly improved.
作者
蒋明远
黄华
路明亮
丁文静
王家平
郑苏云
时鑫
JIANG Ming-yuan;HUANG Hua;LU Ming-liang;DING Wen-jing;WANG Jia-ping;ZHENG Su-yun;SHI Xin(Digestive Endoscopy Center,The First People’s Hospital of Qujing,Qujing 655000;Dept.f Gastroenterology,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)
出处
《昆明医科大学学报》
CAS
2020年第2期32-36,共5页
Journal of Kunming Medical University
基金
国家自然科学基金资助项目(81860144)
云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目[2017FE467(-067)]。
关键词
肝硬化
早期
经颈静脉肝内门体分流术
食管静脉曲张套扎术
食管静脉曲张出血
Liver cirrhosis
Early portasystemic shunt
Transjugular intrahepatic
Endoscopic variceal ligation
Esophageal variceal bleeding
