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建立肝硬化门静脉高压食管胃底静脉曲张破裂出血 急诊绿色通道的可行性、安全性及有效性
Feasibility, safety, and clinical effect of establishing a green channel for the treatment of cirrhotic portal hypertension with esophagogastric variceal bleeding
文章发布日期:2019年04月04日  来源:  作者:周林峰,王万胜,朱晓黎,等  点击次数:341次  下载次数:69次

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【摘要】:目的探讨急诊经颈静脉肝内门体分流术(TIPS)联合食管胃底静脉曲张栓塞(EGVE)治疗门静脉高压食管胃底静脉曲张破裂出血(EGVB)绿色通道建立的可行性、安全性及有效性。方法收集2015年4月1日-2017年12月31日在苏州大学附属第一医院介入科接受TIPS+EGVE治疗的75例患者资料,其中急诊TIPS+EGVE 49例,择期TIPS+EGVE 26例。观察术后止血率、住院时间、术后1年内再出血率、围手术期及术后并发症发生率、1年内病死率等。计量资料2组间比较采用t检验,计数资料2组间比较采用χ2检验,Kaplan-Meier绘制生存曲线比较再出血率。结果75例患者手术均成功实施,术后1周止血率100%,急诊与择期TIPS+EGVE组术后平均住院时间比较差异有统计学意义[(6.1±1.0)d vs (8.1±2.1) d,t=-4.685,P<0.001]。急诊TIPS+EGVE组:2例(4.1%)出现再出血,其中1例(2.0%)术后2个月出现再出血并死亡,另1例术后13个月出现再出血,保守治疗好转后出院;12例(24.5%)随访期间出现至少1次Ⅱ级以上的肝性脑病;择期TIPS+EGVE组:4例(15.4%)术后出现再出血,其中3例(11.5%)死亡,5例(19.2%)出现至少1次Ⅱ级以上肝性脑病,其中1例患者术后1个月出现3次肝性脑病。2组累积再出血率、病死率和肝性脑病发病率比较差异均无统计学意义(P值均>0.05)。术后1个月患者的血氨水平平均值最大,而后逐渐降低。17例发生肝性脑病的患者中有64.7%(11/17)发生在术后1个月内,88.2%(15/17)发生在术后6个月内。结论对于急性EGVB的肝硬化患者,急诊行TIPS联合EGVE绿色通道的建立是可行且安全有效的。
【Abstract】:ObjectiveTo investigate the feasibility, safety, and clinical effect of emergency transjugular intrahepatic portosystemic shunt (TIPS) combined with esophagogastric variceal embolization (EGVE) in establishing a green channel for the treatment of cirrhotic portal hypertension with esophagogastric variceal bleeding (EGVB). MethodsA retrospective analysis was performed for the clinical data of 75 patients who underwent TIPS+EGVE in Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, from April 1, 2015 to December 31, 2017. Among these patients, 49 underwent emergency TIPS+EGVE and 26 underwent elective TIPS+EGVE. Postoperative hemostasis rate, length of hospital stay, rebleeding rate within 1 year after surgery, perioperative and postoperative complications, and mortality rate within 1 year after surgery were observed. The t-test was used for comparison of continuous data between the two groups, the chi-square test was used for comparison of categorical data between the two groups, and the Kaplan-Meier method was used to plot survival curves to compare rebleeding rate. ResultsAll 75 patients underwent a successful surgery, with a hemostasis rate of 100% at 1 week after surgery. There was a significant difference in mean hospital stay between the emergency TIPS+EGVE group and the elective TIPS+EGVE group (6.1±1.0 days vs 8.1±2.1 days, t=-4.685, P<0.001). Among the patients in the emergency TIPS+EGVE group, 2 patients (4.1%) experienced rebleeding, among whom 1 patient (2.0%) experienced rebleeding and died at 2 months after surgery, and the other patient experienced rebleeding at 13 months after surgery and was cured and discharged after conservative treatment; 12 patients (24.5%) had at least one episode of grade ≥2 hepatic encephalopathy during follow-up. Among the patients in the elective TIPS+EGVE group, 4 patients (15.4%) experienced rebleeding after surgery, among whom 3 (11.5%) died; 5 patients (192%) had at least one episode of grade ≥2 hepatic encephalopathy, among whom one patient had three episodes of hepatic encephalopathy within one month after surgery. There were no significant differences between the two groups in cumulative rebleeding rate, mortality rate, and incidence rate of hepatic encephalopathy (P>0.05). Mean blood ammonia level reached the peak at 1 month after surgery and then gradually decreased. Among the 17 patients with hepatic encephalopathy, 11 (64.7%) experienced hepatic encephalopathy within 1 month after surgery, and 15 (88.2%) experienced such disease within 6 months after surgery. ConclusionEmergency TIPS combined with EGVE is feasible, safe, and effective in establishing a green channel in patients with liver cirrhosis and acute EGVB.
【关键字】:肝硬化; 高血压, 门静脉; 门体分流术, 经颈静脉肝内; 栓塞, 治疗性; 食管和胃静脉曲张; 胃肠出血; 回顾性研究
【Key words】:liver cirrhosis; hypertension, portal; portasystemic shunt, transjugular intrahepatic; embolization, therapeutic; esophageal and gastric varices; gastrointestinal hemorrhage; retrospective studies
【引证本文】:ZHOU LF, WANG WS, ZHU XL, et al. Feasibility, safety, and clinical effect of establishing a green channel for the treatment of cirrhotic portal hypertension with esophagogastric variceal bleeding[J]. J Clin Hepatol, 2019, 35(5): 996-1001. (in Chinese)
周林峰, 王万胜, 朱晓黎, 等. 建立肝硬化门静脉高压食管胃底静脉曲张破裂出血急诊绿色通道的可行性、安全性及有效性[J]. 临床肝胆病杂志, 2019, 35(5): 996-1001.

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