TIPS治疗门静脉高压合并上消化道出血的疗效观察
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摘要
目的观察TIPS治疗肝硬化门静脉高压(PHT)合并上消化道出血(UGH)的临床效果以及对血流学的影响。方法将2017年4月—2018年5月确诊为PHT合并UGH的61例患者,随机分为对照组30例和治疗组31例。对照组采用胃冠状静脉栓塞术(GCVE)方式,治疗组在此基础上联合经颈静脉肝内门体分流术(TIPS)。术后随访6个月,记录比较两组患者手术前后直接门静脉压力(PVP)以及门静脉压力梯度(PPG);观察比较两组患者手术前后门静脉内径、门静脉主干压、门静脉流速等血流学指标;观察比较两组患者术后并发症发生情况。结果术前,两组各项指标均差异无统计学意义(P>0.05)。术后两组患者PVP、PPG均较术前下降,但与对照组相比,治疗组PVP、PPG降低更多,差异均有统计学意义(P <0.05);治疗后,两组患者血流学各项指标均改善,但与对照组相比,治疗组改善更优,差异均有统计学意义(P <0.05);且治疗组术后并发症更少,差异有统计学意义(P <0.05)。结论与单用GCVE术相比,联合TIPS与GCVE共同治疗PHT合并UGH的患者,可更加有效降低门静脉压力,减少门静脉内径,且有效增加门静脉流速,疗效确切,且能减少术后并发症的发生,表明TIPS与GCVE联合治疗PHT合并UGH更加安全有效,减少术后风险。
Objective To observe the clinical effect of TIPS in the treatment of cirrhotic portal hypertension(PHT) combined with upper gastrointestinal bleeding(UGH) and its impact on hemodynamics. Methods 61 patients diagnosed with PHT combined with UGH from April 2017 to May 2018 were randomly divided into 30 patients in the control group and 31 patients in the treatment group. The control group was treated with gastric coronary vein embolization(GCVE), and the treatment group was treated with jugular vein intrahepatic portosystemic shunt(TIPS) on this basis.The patients in the two groups were followed up for 6 months after surgery, and the direct portal venous pressure(PVP) and portal venous pressure gradient(PPG) before and after surgery were recorded and compared.To observe and compare the two groups of patients before and after surgery portal vein diameter, portal vein pressure, portal velocity and other blood flow indicators;The postoperative complications of the two groups were observed and compared. Results Before the operation, there was no statistical difference in each index between the two groups(P > 0.05). PVP and PPG decreased in both groups after surgery compared with that before surgery. However, compared with the control group, PVP and PPG decreased more in the treatment group, and the differences were statistically significant(P < 0.05). After treatment, all hemodynamic parameters in the two groups were improved, but compared with the control group, the improvement was better in the treatment group, and the differences were statistically significant(P < 0.05). There were fewer postoperative complications in the treatment group, and the difference was statistically significant(P < 0.05). Conclusion Compared with GCVE surgery alone, joint TIPS and GCVE treatment of PHT 'combined together, can more effectively reduce portal vein pressure, reduce portal vein diameter, and effectively increase the portal velocity, curative effect, and can reduce the occurrence of postoperative complications, TIPS and GCVE joint merger of PHT' more safe and effective treatment, reduce the risk of postoperative.
Objective To observe the clinical effect of TIPS in the treatment of cirrhotic portal hypertension(PHT) combined with upper gastrointestinal bleeding(UGH) and its impact on hemodynamics. Methods 61 patients diagnosed with PHT combined with UGH from April 2017 to May 2018 were randomly divided into 30 patients in the control group and 31 patients in the treatment group. The control group was treated with gastric coronary vein embolization(GCVE), and the treatment group was treated with jugular vein intrahepatic portosystemic shunt(TIPS) on this basis.The patients in the two groups were followed up for 6 months after surgery, and the direct portal venous pressure(PVP) and portal venous pressure gradient(PPG) before and after surgery were recorded and compared.To observe and compare the two groups of patients before and after surgery portal vein diameter, portal vein pressure, portal velocity and other blood flow indicators;The postoperative complications of the two groups were observed and compared. Results Before the operation, there was no statistical difference in each index between the two groups(P > 0.05). PVP and PPG decreased in both groups after surgery compared with that before surgery. However, compared with the control group, PVP and PPG decreased more in the treatment group, and the differences were statistically significant(P < 0.05). After treatment, all hemodynamic parameters in the two groups were improved, but compared with the control group, the improvement was better in the treatment group, and the differences were statistically significant(P < 0.05). There were fewer postoperative complications in the treatment group, and the difference was statistically significant(P < 0.05). Conclusion Compared with GCVE surgery alone, joint TIPS and GCVE treatment of PHT 'combined together, can more effectively reduce portal vein pressure, reduce portal vein diameter, and effectively increase the portal velocity, curative effect, and can reduce the occurrence of postoperative complications, TIPS and GCVE joint merger of PHT' more safe and effective treatment, reduce the risk of postoperative.
引文
[1]汤善宏,曾维政,吴晓玲,等.肝硬化门静脉高压侧支循环的形成及临床意义[J].临床肝胆病杂志,2016,32(8):1613-1616.
[2]张嘉瑜,刘龙平,王成林.肝硬化门静脉高压侧支血管开放的影像学特征及临床意义[J].中国CT和MRI杂志,2016,14(1):77-80,122.
[3]贺加星,阴继凯,刘凡,等.肝硬化门静脉高压并发上消化道出血的相关危险因素分析[J].中国普通外科杂志,2015,24(1):127-129.
[4]丁惠国,徐小元,令狐恩强,等.《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》解读[J].中华内科杂志,2016,55(2):57-72.
[5]李海.掌握发病新机制,有效防治肝硬化门静脉高压出血[J].胃肠病学,2015,20(11):641-643.
[6]邵庆华,郑盛,杨涓,等.经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗肝硬化门静脉高压症上消化道出血中远期疗效评价[J].肝脏,2016,21(1):17-20,65.
[7]韩丹,张韬,张跃新.肝硬化上消化道出血的危险因素分析[J].成都医学院学报,2016,11(1):62-64.
[8]吴琼玉,黄玉,王庭学,等.上消化道出血行急诊护理的效果观察[J].现代消化及介入诊疗,2016,21(1):163-165.
[9]吴继雄,张国飞.不同介入方法治疗门静脉高压引起的上消化道出血的对照研究[J].现代消化及介入诊疗,2016,21(2):256-258.
[10]贺克武,张国兵. TIPS治疗门静脉高压[J].肝胆外科杂志,2017,25(5):328-331.
[11]孙世蒙,郭应兴,雷振武,等. TIPS治疗肝硬化门静脉高压的临床研究现状[J].青海医药杂志,2016,46(11):77-80.
[12]张铠,赵卫. TIPS联合胃冠状静脉栓塞治疗肝硬化门静脉高压伴上消化道出血[J].介入放射学杂志,2017,26(7):601-606.
[2]张嘉瑜,刘龙平,王成林.肝硬化门静脉高压侧支血管开放的影像学特征及临床意义[J].中国CT和MRI杂志,2016,14(1):77-80,122.
[3]贺加星,阴继凯,刘凡,等.肝硬化门静脉高压并发上消化道出血的相关危险因素分析[J].中国普通外科杂志,2015,24(1):127-129.
[4]丁惠国,徐小元,令狐恩强,等.《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》解读[J].中华内科杂志,2016,55(2):57-72.
[5]李海.掌握发病新机制,有效防治肝硬化门静脉高压出血[J].胃肠病学,2015,20(11):641-643.
[6]邵庆华,郑盛,杨涓,等.经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗肝硬化门静脉高压症上消化道出血中远期疗效评价[J].肝脏,2016,21(1):17-20,65.
[7]韩丹,张韬,张跃新.肝硬化上消化道出血的危险因素分析[J].成都医学院学报,2016,11(1):62-64.
[8]吴琼玉,黄玉,王庭学,等.上消化道出血行急诊护理的效果观察[J].现代消化及介入诊疗,2016,21(1):163-165.
[9]吴继雄,张国飞.不同介入方法治疗门静脉高压引起的上消化道出血的对照研究[J].现代消化及介入诊疗,2016,21(2):256-258.
[10]贺克武,张国兵. TIPS治疗门静脉高压[J].肝胆外科杂志,2017,25(5):328-331.
[11]孙世蒙,郭应兴,雷振武,等. TIPS治疗肝硬化门静脉高压的临床研究现状[J].青海医药杂志,2016,46(11):77-80.
[12]张铠,赵卫. TIPS联合胃冠状静脉栓塞治疗肝硬化门静脉高压伴上消化道出血[J].介入放射学杂志,2017,26(7):601-606.
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