肝硬化门静脉高压并发上消化道出血的3种手术方式比较分析

温建生; 岳琨; 吴智群; 路红娟

doi:10.3969/j.issn.1001-5256.2016.02.013

肝硬化门静脉高压并发上消化道出血的3种手术方式比较分析

DOI: 10.3969/j.issn.1001-5256.2016.02.013

1. 陕西省铜川矿务局中心医院介入中心
2. 第四军医大学附属唐都医院介入放射科

详细信息

中图分类号: R575.2;R573.2
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出版历程
- 收稿日期: 2015-07-14
- 出版日期: 2016-02-20

Comparative clinical analysis of three surgical methods in patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding

Intervention Center,Tongchuan Mining Bureau Central Hospital

摘要

摘要:
目的比较经颈静脉肝内门体分流术（TIPS）、经皮经肝食管胃底静脉曲张栓塞术（PTVE）及TIPS联合胃冠状静脉栓塞术（GCVE）在肝硬化晚期门静脉高压患者并发上消化道出血治疗中的效果及优劣性。方法回顾性分析2012年1月-2014年10月于铜川矿务局中心医院行手术治疗的肝硬化晚期门静脉高压并发上消化道出血患者167例,根据手术方法不同分为TIPS组（n=56）、PTVE组（n=53）及TIPS联合GCVE组（n=58）。比较3组患者治疗的手术时间、术后恢复时间、住院费用,术后消化道曲张改善程度、再出血发生率、肝性脑病发生率、腹水消除率,门静脉相关指标（门静脉内径、门静脉流速、门静脉压力）及肝功能指标（ALT、AST、TBil、白蛋白）的不同。计量资料多组间比较采用方差分析,进一步两两比较采用SNK-q检验;计数资料组间比较采用χ2检验。结果 3组的手术时间、住院费用、术后再出血发生率及术后肝性脑病发生率比较,差异均有统计学意义（F值分别为13.85、12.53,P值均<0.05;χ2值分别为7.132、6.368,P值均<0.05）。其中,TIPS组与PTVE组的住院费用比...
- 肝硬化 /
- 门静脉高压 /
- 食管和胃静脉曲张 /
- 门体分流术,经颈静脉肝内 /
- 栓塞,治疗性
Abstract:
Objective To compare the effects of transjugular intrahepatic portosystemic shunt( TIPS),percutaneous transhepatic variceal embolization( PTVE),and TIPS combined with gastric coronary vein embolization( GCVE) in patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding. Methods A total of 167 patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding who underwent surgical treatment in Tongchuan Mining Bureau Central Hospital from January 2012 to October 2014 were analyzed retrospectively and divided into TIPS group( 56 patients),PTVE group( 53 patients),and TIPS- GCVE group( 58 patients) according to the difference in surgical method. The time of operation,time to postoperative recovery,hospital costs,postoperative improvement in gastrointestinal varices,incidence of rebleeding,incidence of hepatic encephalopathy,ascites elimination rate,indices related to the portal vein( diameter of the portal vein,portal vein velocity,portal venous pressure),and liver function parameters( ALT,AST,TBil,and Alb) were compared between the three groups. Comparison of continuous data between these groups was made by analysis of variance,and pairwise comparison was made by SNK- q test; comparison of categorical data between these groups was made by chis- quare test.Results There were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the three groups( F = 13. 85 and 12. 53,respectively,χ2= 7. 132 and 6. 368,respectively,all P < 0. 05). The hospital costs showed a significant difference between the TIPS group and the PTVE group( q = 2. 84,P < 0. 05); there were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the TIPS group and the TIPS- GCVE group( q = 3. 99 and 2. 58,respectively,χ2= 7. 396 and 6. 183,respectively,all P < 0. 05); there were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the PTVE group and the TIPS- GCVE group( q = 4. 53 and 3. 99,respectively,χ2=7. 534 and 5. 461,respectively,all P < 0. 05). Conclusion Although TIPS- GCVE has longer time of operation and higher hospital costs than TIPS and PTVE,it can significantly reduce the incidence of postoperative rebleeding and hepatic encephalopathy.
- liver cirrhosis /
- portal hypertension /
- esophageal and gastric varices /
- portasystemic shunt,transjugular intrahepatic /
- embolization,therapeutic

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参考文献(18)

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