發(fā)布時間：2018-10-31 10:52

【摘要】：目的對比單純TIPS和TIPS聯(lián)合胃冠狀靜脈栓塞術(GCVE)治療肝硬化門靜脈高壓癥(PHT)伴上消化道出血(UGH),分析TIPS和GCVE聯(lián)合應用的必要性、可行性及臨床療效。方法回顧性分析2010年4月至2012年5月收治的38例PHT伴UGH患者臨床資料,其中接受單純TIPS治療15例(A組),TIPS聯(lián)合GCVE治療23例(B組),觀察分析手術前后血液指標、門靜脈及脾臟血流動力學、脾臟形態(tài)學、消化道靜脈曲張程度變化。隨訪術后并發(fā)癥發(fā)生情況。結果兩組術后門靜脈壓降低、流速加快、脾靜脈淤血指數(shù)降低均較術前明顯(P0.05),B組均優(yōu)于A組(P0.05)。術后兩組食管胃底靜脈曲張(EGV)均明顯好轉(P0.05),B組和A組EGV好轉率分別為94.7%、66.6%,急診止血率分別為100%、75%,再出血率分別為4.3%、28.5%,B組均明顯優(yōu)于A組(P0.05)。手術前后肝功能指標組內(nèi)、組間比較,差異均無統(tǒng)計學意義(P0.05)。兩組術后肝性腦病(HE)發(fā)生率、支架原發(fā)通暢率差異均無統(tǒng)計學意義(P0.05)。兩組再介入通暢率均為100%,支架遠端位于門靜脈左支者HE發(fā)生率顯著低于位于右支者(P0.05)。結論 TIPS聯(lián)合GCVE治療肝硬化PHT伴UGH療效確切,優(yōu)于單純TIPS。
[Abstract]:Objective to compare the necessity, feasibility and clinical efficacy of TIPS and TIPS combined with gastric coronary vein embolization (GCVE) in the treatment of portal hypertension (PHT) with upper gastrointestinal hemorrhage. Methods the clinical data of 38 PHT patients with UGH were retrospectively analyzed from April 2010 to May 2012, of which 15 cases were treated with TIPS alone (Group A,), TIPS combined with GCVE, 23 cases, Group B). The blood indexes before and after operation were observed and analyzed. The hemodynamics of portal vein and spleen, the morphology of spleen and the degree of digestive tract varices. Postoperative complications were followed up. Results the portal vein pressure decreased, the velocity of blood flow accelerated and the index of splenic vein congestion decreased significantly in both groups (P0.05) compared with that before operation (P0.05) in), B group was better than that in A group (P0.05). The (EGV) of esophageal and gastric fundus varices in the two groups were improved significantly after operation (P 0.05, the improvement rates of EGV in group), B and group A were 94.7and 66.6, respectively. The emergency hemostatic rate was 10075 and the rate of rebleeding was 4.3, respectively. Group B was significantly better than group A (P0.05). There was no significant difference in liver function between groups before and after operation (P0.05). There was no significant difference in the incidence of (HE) and the primary patency rate of stent between the two groups (P0.05). The patency rate of re-intervention in both groups was 100. The incidence of HE in patients with distal stent located in the left portal vein was significantly lower than that in the right branch (P0.05). Conclusion TIPS combined with GCVE is more effective than TIPS. alone in the treatment of PHT with UGH in cirrhotic patients.
【作者單位】： 成都軍區(qū)昆明總醫(yī)院血管外科;昆明醫(yī)科大學第一附屬醫(yī)院醫(yī)學影像中心;
【分類號】：R575.2

【參考文獻】

相關期刊論文 前10條

1 陳翔;李金輝;許建榮;程杰軍;張慶;吳華偉;嚴峗琦;周孝雯;曾帥;馬捚;陳勝良;;經(jīng)皮經(jīng)肝食管胃底曲張靜脈栓塞術聯(lián)合部分脾栓塞術治療肝硬化食管胃底靜脈曲張破裂出血療效觀察[J];胃腸病學;2016年04期

2 胡培欣;張淑紅;;急性食管胃靜脈曲張破裂出血的診治進展[J];世界華人消化雜志;2015年35期

3 ;經(jīng)頸靜脈肝內(nèi)門體靜脈分流術治療肝硬化門靜脈高壓共識意見[J];臨床肝膽病雜志;2014年03期

4 畢光榮;張勇;陳旭f;;經(jīng)頸靜脈肝內(nèi)門體分流術聯(lián)合胃冠狀靜脈栓塞術治療門脈高壓上消化道出血的臨床療效[J];介入放射學雜志;2013年03期

5 宋偉中;;簡化聯(lián)合斷流術在急診門脈高壓上消化道大出血手術中的應用[J];中國實用醫(yī)藥;2012年14期

6 丁鵬緒;張文廣;韓新巍;任建莊;李臻;周朋利;馬彥高;麻恒翔;;改良式TIPS治療肝靜脈廣泛阻塞型布-加綜合征的近期療效[J];介入放射學雜志;2011年02期

7 李靈敏;肖天利;廖化禹;陳磊;龍慶林;汪榮泉;陳文生;;經(jīng)頸靜脈肝內(nèi)門體分流術對進展期肝硬化患者肝腎功能的影響[J];第三軍醫(yī)大學學報;2010年20期

8 趙延軍;韓國宏;殷占新;何創(chuàng)業(yè);白飛虎;李瑞軍;白葦;牛靜;郭文剛;;經(jīng)頸靜脈肝內(nèi)門體靜脈分流(TIPS)術后并發(fā)肝性腦病的臨床分析[J];當代醫(yī)學;2010年11期

9 蔣安;李宗芳;王志東;周蕊;黎一鳴;楊正安;普彥淞;郭彥鋒;;肝硬化門靜脈高壓癥分流術和斷流術療效比較的Meta分析[J];中華普通外科學文獻(電子版);2010年01期

10 劉偉;陳洪波;陳根生;張衛(wèi)平;曾群;;介入斷流術治療門脈高壓上消化道大出血的中遠期隨訪結果[J];介入放射學雜志;2009年06期

【共引文獻】

相關期刊論文 前10條

1 張鎧;趙衛(wèi);;TIPS聯(lián)合胃冠狀靜脈栓塞治療肝硬化門靜脈高壓伴上消化道出血[J];介入放射學雜志;2017年07期

2 戴晏平;高青;;肝硬化食管胃靜脈曲張出血內(nèi)鏡診療進展[J];現(xiàn)代醫(yī)藥衛(wèi)生;2017年13期

3 陳輝;呂勇;王秋和;殷占新;何創(chuàng)業(yè);左羅;邵晶;;經(jīng)頸靜脈肝內(nèi)門體分流術專家共識[J];臨床肝膽病雜志;2017年07期

4 黃立江;;內(nèi)鏡下同步聯(lián)合對食管胃底靜脈曲張患者安全性[J];世界華人消化雜志;2017年16期

5 譚勝蘭;;TIPS術后肝性腦病的預見性護理[J];當代護士(上旬刊);2017年04期

6 馬婧]，

本文編號：2301908