CAJ | 학술논문

目的探讨经颈静脉肝内门体分流术(TIPS)术后上消化道再出血的原因及发病机制.方法选择50例行TIPS患者,对其进行观察随访,分析各种因素在术后上消化道再出血中的作用.结果 50例行TIPS患者门静脉压力由术前(39.8±9.2)cmH2O(1 cmH2O =0.098 kPa)降至术后(25.2±5.8) cmH2O,差异有统计学意义(P＜0.05).14例患者术后出现上消化道再出血,发生率为28％(14/50),其中3例在术后3d内出现呕吐鲜血,考虑急性胃黏膜病变出血,经内科治疗后短期内出血均得到控制(其中1例患者在术后1年余再发上消化道出血);12例患者在TIPS术后2年内出现上消化道再出血,出血原因:6例为食管胃底静脉曲张破裂再出血,3例为胃十二指肠溃疡,2例为糜烂性胃炎,1例与凝血异常有关.食管胃底静脉曲张破裂再出血发生率为12％(6/50).结论 TIPS术后并发上消化道再出血的原因主要分为静脉曲张性再出血和非静脉曲张性再出血二种,二者均是TIPS术后重要的再出血原因,静脉曲张性再出血多发生于术后3个月以上,而非静脉曲张性再出血多发生于术后3个月以内.因此对术后患者常规给予质子泵抑制剂保护胃黏膜十分重要.
목적 탐토경경정맥간내문체분류술(TIPS)술후상소화도재출혈적원인급발병궤제.방법 선택50례행TIPS환자,대기진행관찰수방,분석각충인소재술후상소화도재출혈중적작용.결과 50례행TIPS환자문정맥압력유술전(39.8±9.2)cmH2O(1 cmH2O =0.098 kPa)강지술후(25.2±5.8) cmH2O,차이유통계학의의(P＜0.05).14례환자술후출현상소화도재출혈,발생솔위28％(14/50),기중3례재술후3d내출현구토선혈,고필급성위점막병변출혈,경내과치료후단기내출혈균득도공제(기중1례환자재술후1년여재발상소화도출혈);12례환자재TIPS술후2년내출현상소화도재출혈,출혈원인:6례위식관위저정맥곡장파렬재출혈,3례위위십이지장궤양,2례위미란성위염,1례여응혈이상유관.식관위저정맥곡장파렬재출혈발생솔위12％(6/50).결론 TIPS술후병발상소화도재출혈적원인주요분위정맥곡장성재출혈화비정맥곡장성재출혈이충,이자균시TIPS술후중요적재출혈원인,정맥곡장성재출혈다발생우술후3개월이상,이비정맥곡장성재출혈다발생우술후3개월이내.인차대술후환자상규급여질자빙억제제보호위점막십분중요.
Objective To study the pathogenesis of upper gastrointestinal rehaemorrhagia after the transjugular intrahepatic portasystemic shunt (TIPS) and its influencing factor.Methods Fifty postoperative patients with TIPS were selected.The patients were followed-up,and the effect of the various factors in the role of upper gastrointestinal rehaemorrhagia after TIPS was analyzed.Results The portal vein pressure of 50 patients with TIPS decreased from preoperative (39.8 ±9.2) cmH2O (1 cmH2O =0.098 kPa) to postoperative (25.2 ± 5.8) cmH2O,and there was statistical difference (P ＜ 0.05).Fourteen patients appeared upper gastrointestinal rehaemorrhagia after TIPS,which accounted for total of 28％ (14/50) and included 3 cases of postoperative vomiting blood within 3 days.Acute stomach mucosa lesions bleeding was considered,and bleeding was controlled within a short-term medical treatment (1 patient after more than a year in recurrent upper gastrointestinal rehaemorrhagia).Twelve cases of patients appeared upper gastrointestinal rehaemorrhagia within 2 years after TIPS,and the causes of rehaemorrhagia in 6 cases were esophageal variceal rehaemorrhagia,gastric and duodenal ulcer in 3 cases,erosive gastritis in 2 cases,coagulation abnormalities in 1 case.Esophageal variceal rehaemorrhagia rate was 12％ (6/50).Conclusions The main reasons of upper gastrointestinal rehaemorrhagia after TIPS are variceal rehaemorrhagia and non variceal rehaemorrhagia,both of which are important causes of rehaemorrhagia after TIPS.Variceal rehaemorrhagia after TIPS occurs more than 3 months,and non variceal rehaemorrhagia occurs within 3months,so it is very important to protect gastric mucosa with proton pump inhibitor in postoperative patients.