浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2013年
16期
1508-1509,1512
,共3页
陈旭艳%陈坛輈%林介军%吴伟%黄智铭
陳旭豔%陳罈輈%林介軍%吳偉%黃智銘
진욱염%진단주%림개군%오위%황지명
经颈静脉肝内门体分流术%食管和胃静脉曲张%肝硬化
經頸靜脈肝內門體分流術%食管和胃靜脈麯張%肝硬化
경경정맥간내문체분류술%식관화위정맥곡장%간경화
Transjugular intrahepatic portasystemic shunt%Esophageal and gastric varices%Liver cirrhosis
目的探讨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(EGVB)的临床效果。方法收集35例因肝硬化失代偿期合并EGVB行TIPS术的患者的资料,观察近期疗效,包括术后24h止血率、平均门静脉压力、术后肝功能指标(胆碱脂酶、总胆红素、白蛋白)及凝血酶原时间,并与术前比较,并观察肝性脑病及支架阻塞发生情况。结果35例患者中34例成功实施TIPS,其中1例因血管变异无法经常规路径进入门静脉。术后24h止血率为100%。34例成功实施TIPS的患者,平均门静脉压力从(38.01±4.75)cmH2O降低至(25.04±3.14)cmH2O,手术前、后比较,差异有统计学意义(P<0.01)。胆碱脂酶活性、总胆红素、白蛋白、凝血酶原时间术后3d与术前比较,差异均无统计学意义(均P>0.05)。患者术后随访1~12个月,肝性脑病发生率为14.71%(5/34),其中1例严重肝性脑病患者予以再次行TIPS术置入限流支架,病情好转。早期再出血率(72h~6周)为0%(0/34),迟发性再出血率(6周~12个月)为5.88%(2/34),肝功能衰竭发生率为2.94%(1/34),术后支架阻塞率为5.88%(2/34),病死率为0%(0/34)。结论 TIPS治疗肝硬化食管胃底EGVB效果确切,安全可靠。
目的探討經頸靜脈肝內門體分流術(TIPS)治療肝硬化食管胃底靜脈麯張破裂齣血(EGVB)的臨床效果。方法收集35例因肝硬化失代償期閤併EGVB行TIPS術的患者的資料,觀察近期療效,包括術後24h止血率、平均門靜脈壓力、術後肝功能指標(膽堿脂酶、總膽紅素、白蛋白)及凝血酶原時間,併與術前比較,併觀察肝性腦病及支架阻塞髮生情況。結果35例患者中34例成功實施TIPS,其中1例因血管變異無法經常規路徑進入門靜脈。術後24h止血率為100%。34例成功實施TIPS的患者,平均門靜脈壓力從(38.01±4.75)cmH2O降低至(25.04±3.14)cmH2O,手術前、後比較,差異有統計學意義(P<0.01)。膽堿脂酶活性、總膽紅素、白蛋白、凝血酶原時間術後3d與術前比較,差異均無統計學意義(均P>0.05)。患者術後隨訪1~12箇月,肝性腦病髮生率為14.71%(5/34),其中1例嚴重肝性腦病患者予以再次行TIPS術置入限流支架,病情好轉。早期再齣血率(72h~6週)為0%(0/34),遲髮性再齣血率(6週~12箇月)為5.88%(2/34),肝功能衰竭髮生率為2.94%(1/34),術後支架阻塞率為5.88%(2/34),病死率為0%(0/34)。結論 TIPS治療肝硬化食管胃底EGVB效果確切,安全可靠。
목적탐토경경정맥간내문체분류술(TIPS)치료간경화식관위저정맥곡장파렬출혈(EGVB)적림상효과。방법수집35례인간경화실대상기합병EGVB행TIPS술적환자적자료,관찰근기료효,포괄술후24h지혈솔、평균문정맥압력、술후간공능지표(담감지매、총담홍소、백단백)급응혈매원시간,병여술전비교,병관찰간성뇌병급지가조새발생정황。결과35례환자중34례성공실시TIPS,기중1례인혈관변이무법경상규로경진입문정맥。술후24h지혈솔위100%。34례성공실시TIPS적환자,평균문정맥압력종(38.01±4.75)cmH2O강저지(25.04±3.14)cmH2O,수술전、후비교,차이유통계학의의(P<0.01)。담감지매활성、총담홍소、백단백、응혈매원시간술후3d여술전비교,차이균무통계학의의(균P>0.05)。환자술후수방1~12개월,간성뇌병발생솔위14.71%(5/34),기중1례엄중간성뇌병환자여이재차행TIPS술치입한류지가,병정호전。조기재출혈솔(72h~6주)위0%(0/34),지발성재출혈솔(6주~12개월)위5.88%(2/34),간공능쇠갈발생솔위2.94%(1/34),술후지가조새솔위5.88%(2/34),병사솔위0%(0/34)。결론 TIPS치료간경화식관위저EGVB효과학절,안전가고。
Objective To evaluate the application of transjugular intrahepatic portosystemic stent- shunt(TIPS) in treatment of esophagogastric varices bleeding (EGVB) in cirrhosis patients. Methods Thirty five patients with EGVB due to liver cirrhosis received TIPS and were fol owed up for 12 months at the First Affiliated Hospital of Wenzhou Medical University and Wenzhou Central Hospital. The short- term effects, including 24h hemostasis rates after TIPS and average portal pressure were observed. The levels of cholinesterase,total bilirubin,albumin,and prothrombin time were also evaluated after TIPS. The occurrence of hep-atic encephalopathy and obstruction of stents after TIPs were also observed. Results The TIPS was successful y performed in 34 out of 35 patients with a total effective rate of 97.14%and the rate of 24h hemostatsis was 100.0%.Average portal pressure dropped from (38.01±4.75)cmH2O to (25.04±3.14) cmH2O after treatment (P<0.01). There were no significant differences in cholinesterase, total bilirubin,albumin, and prothrombin time before and three days after operation(P>0.05). The incidence rate of hepatic encephalopathy was 14.71%(5/34).The relapse rate of early rehemorrhagia (72h to 6 weeks) was 0%(0/34) and that of tardive rehaemorrhagia(6 to 12 months) was 5.88%(2/34).The incidence rate of hepatic failure was 2.94%(1/34). The rate of stent obstruction was 5.88%(2/34). No death occurred in the patients. Conclusion TIPS is effective and safe in treatment of esopha-gogastric varices bleeding caused by liver cirrhosis.