CAJ | 학술논문

目的探讨急诊经颈静脉肝内门体静脉分流术(TIPS)治疗急性肝硬化食管胃静脉曲张破裂出血(EGVB)的可行性、安全性和疗效.方法回顾性分析12例行急诊TIPS治疗的肝硬化EGVB患者资料,并与90例行择期TIPS预防再出血的肝硬化患者相比较,观察止血成功情况、再出血情况、肝静脉门静脉压力梯度(HPPG)、肝功能、肝性脑病与死亡情况等.计量资料行t检验,计数资料行卡方检验,采用Kaplan-Meier生存曲线比较累积再出血率.结果 12例患者急诊TIPS均成功实施,术后出血即止.其中8例患者行HPPG测定,术后[(15.8±5.9) mmHg,1 mmHg=0.133 kPa]较术前[(20.7±5.0) mmHg]下降明显,差异有统计学意义(t=4.022,P=0.005).术前肝功能(CTP)评分为6.6±1.5,术后为6.5±1.3,差异无统计学意义(P＞0.05).术后1周内,12例行急诊TIPS的患者中3例出现肝性脑病,择期TIPS组肝性脑病发生率为18％(16/90),两组差异无统计学意义(P＞0.05).随访期内,11例随访的行急诊TIPS的患者中,1例出现再出血;择期TIPS组的再出血率为21％(19/90);两组累积再出血情况比较差异无统计学意义(P＞0.05).急诊TIPS组无死亡病例,择期TIPS组总体病死率为13％(12/90),其中EGVB及肝功能衰竭相关病死率为9％(8/90).结论急诊TIPS治疗急性肝硬化EGVB安全可行,疗效令人满意.
목적 탐토급진경경정맥간내문체정맥분류술(TIPS)치료급성간경화식관위정맥곡장파렬출혈(EGVB)적가행성、안전성화료효.방법 회고성분석12례행급진TIPS치료적간경화EGVB환자자료,병여90례행택기TIPS예방재출혈적간경화환자상비교,관찰지혈성공정황、재출혈정황、간정맥문정맥압력제도(HPPG)、간공능、간성뇌병여사망정황등.계량자료행t검험,계수자료행잡방검험,채용Kaplan-Meier생존곡선비교루적재출혈솔.결과 12례환자급진TIPS균성공실시,술후출혈즉지.기중8례환자행HPPG측정,술후[(15.8±5.9) mmHg,1 mmHg=0.133 kPa]교술전[(20.7±5.0) mmHg]하강명현,차이유통계학의의(t=4.022,P=0.005).술전간공능(CTP)평분위6.6±1.5,술후위6.5±1.3,차이무통계학의의(P＞0.05).술후1주내,12례행급진TIPS적환자중3례출현간성뇌병,택기TIPS조간성뇌병발생솔위18％(16/90),량조차이무통계학의의(P＞0.05).수방기내,11례수방적행급진TIPS적환자중,1례출현재출혈;택기TIPS조적재출혈솔위21％(19/90);량조루적재출혈정황비교차이무통계학의의(P＞0.05).급진TIPS조무사망병례,택기TIPS조총체병사솔위13％(12/90),기중EGVB급간공능쇠갈상관병사솔위9％(8/90).결론 급진TIPS치료급성간경화EGVB안전가행,료효령인만의.
Objective To investigate the feasibility,safety and efficacy of emergency transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of esophageal and gastric variceal bleeding (EGVB) in liver cirrhosis.Methods The clinical data of 12 patients with liver cirrhosis and EGVB undergoing emergency TIPS were retrospectively analyzed,and were compared with those of 90 patients with cirrhosis undergoing selective TIPS for preventing rebleeding.The haemostasis,rebleeding,hepaticportal vein pressure gradient (HPPG),liver function,hepatic encephalopathy and death were observed.The t-test was performed for measurement data,while Chi-square test was used for counting data and Kaplan-Meier survival curves was used to compare the cumulative rebleeding rate.Results All emergency TIPS of the 12 patients were successful,the bleeding stopped after operation.Among them,eight patients underwent HPPG examination,which significantly decreased after operation ((15.8 ±5.9) mmHg,1 mmHg=0.133 kPa) compared with that before operation ((20.7±5.0) mmHg) and the difference was statistically significant (t =4.022,P=0.005).The liver function (Child-Turcotte-Pugh,CTP) score was 6.6 ± 1.5 before operation and 6.5 ± 1.3 after operation,there was no significant difference (P＞0.05).Hepatic encephalopathy occurred in three patients of the 12 cases undergoing emergency TIPS within one week after operation.The rate of hepatic encephalopathy in selective TIPS group was 18％ (16/90) and there was no significant difference (P＞0.05).During the follow-up period,rebleeding occurred in one patient of the 11 followed up cases undergoing emergency TIPS,while the cumulative rebleeding rate was 21 ％ (19/90) in the selective TIPS group and there was no significant difference in cumulative rebleeding between two groups (P＞0.05).There was no dead case in the emergency TIPS group while the overall mortality of selective TIPS group was 13％ (12/90),in which the EGVB and liver function failure-related mortality was 9％ (8/90).Conclusion The emergency TIPS is feasible,safe and with satisfactory efficacy in the treatment of acute EGVB in liver cirrhosis.