消化内镜序贯TIPS在肝硬化急性食管胃静脉曲张破裂出血中的应用研究

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中文摘要：目的评估内镜序贯经颈静脉肝内门体分流术(TIPS)治疗肝硬化急性食管胃静脉曲张破裂出血(EGVB)的安全性及有效性.方法将2019 年9 月—2021 年3 月接受内镜序贯TIPS治疗的肝硬化急性EGVB 31 例作为内镜序贯TIPS组,将接受单纯内镜序贯治疗的46 例作为内镜序贯组.观察内镜序贯TIPS组门静脉压力梯度变化情况,比较2 组静脉曲张改善程度及肝功能变化,术后1、3、6、12 个月再出血率及肝性脑病发生率,随访结束后分析2 组生存情况.结果内镜序贯TIPS组术后门静脉压力梯度低于术前(P<0.01).内镜序贯TIPS组术后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)术后1 个月高于其他时点(P<0.05),术后3 个月开始下降;内镜序贯TIPS组术后血清胆红素升高,术后3 个月直接胆红素(DBIL)和间接胆红素(IBIL)升至高峰,术后 6 个月逐渐下降(P<0.05).内镜序贯组术后3、7dALT、AST较术前降低,ALB较术前升高(P<0.05);术后1 个月总胆红素(TBIL)水平低于术前(P<0.05);术后7d及术后1、3 个月DBIL低于术前(P<0.05).2 组术后静脉曲张根除率比较差异无统计学意义(P>0.05).内镜序贯TIPS组术后6、12 个月再出血率低于内镜序贯组(P<0.01);2 组术后肝性脑病发生率及术后1 年生存率比较差异均无统计学意义(P>0.05).结论 TIPS可降低门静脉压力,静脉曲张根除率与内镜序贯治疗相当,但可有效降低再出血率,而并不降低生存率且不增加肝性脑病发生率.内镜序贯TIPS治疗肝硬化EVGB安全有效.

外文标题：Application of Digestive Endoscopic Sequential TIPS Therapy in the Treat-ment of Esophagoegastric Variceal Bleeding in Patients with Liver Cirrho-sis

外文摘要：Objective To evaluate the safety and efficacy of endoscopic sequential transjugular intrahepatic portal shunt(TIPS)in the treatment of acute esophagogastric variceal bleeding(EGVB)in patients with liver cirrhosis.Methods Thirty-one cirrhosis patients with acute EGVB who received endoscopic sequential TIPS from September 2019 to March 2021 were classified as the endoscopic sequential TIPS group,and 46 patients who received endoscopic sequential therapy alone were classified as the endoscopic sequential TIPS group.The change of portal vein pressure gradient in the endoscopic sequen-tial TIPS group was observed,and the improvement degree of varicose veins and liver function of the two groups,as well as the rate of rebleeding and the incidence of hepatic encephalopathy at 1,3,6 and 12 months after surgery,were compared.The survival of the two groups was analyzed after follow-up.Results The portal vein pressure gradient in the endoscopic sequen-tial TIPS group after operation was lower than that before operation(P<0.01).Alanine aminotransferase(ALT)and aspar-tate aminotransferase(AST)in the endoscopic sequential TIPS group at 1 month after operation were higher than those at other time points(P<0.05),and began to decrease at 3 months after operation.The postoperative serum bilirubin levels were ele-vated,and direct bilirubin(DBIL)and indirect bilirubin(IBIL)reached the peak at 3 months after operation,and gradually decreased at 6 months after operation(P<0.05)in the endoscopic sequential TIPS group.ALT and AST were lower and ALB was higher in the sequential endoscopic group at 3 and 7 days after operation than those before operation(P<0.05),while the level of TBIL at 1 month after operation was lower than that before operation(P<0.05).The DBIL at 1 week and 1 and 3 months after operation was lower than that before operation(P<0.05).There was no significant difference in the eradica-tion rate of varicose veins between the two groups(P>0.05).The rate of rebleeding at 6 and12 months after operation in the sequential TIPS group was lower than that in the sequential TIPS group(P<0.01).There was no significant difference in the incidence of postoperative hepatic encephalopathy and 1-year survival rate between the two groups(P>0.05).Conclusion TIPS can reduce the portal vein pressure,and the eradication rate of varicose veins is comparable to that of sequential endo-scopic therapy,but it can effectively reduce the rate of rebleeding without decreasing the survival rate and increasing the inci-dence of hepatic encephalopathy.Endoscopic sequential TIPS is safe and effective in the treatment of EVGB in patients with liver cirrhosis.

外文关键词：

Liver cirrhosisEsophageal and gastric varicesPortal hypertensionTransjugular intrahepatic portosys-temic shuntEndoscopic treatmentAlanine transaminaseBilirubinHepatic encephalopathy

作者：

刘思琦、陈雷、史程怡、刘昆毅、张学强、王娜

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作者单位：

050000 石家庄,河北医科大学第二医院消化内科河北省消化病研究所河北省消化病重点实验室国家消化病临床医学研究中心河北省分中心

300121 天津,天津市人民医院重症医学科

关键词：

肝硬化食管和胃静脉曲张门静脉高压经颈静脉肝内门体分流术内镜治疗丙氨酸转氨酶胆红素肝性脑病

基金：

河北省重点研发计划民生科技专项河北省直医疗机构老年病防治项目河北省政府资助省级医学优秀人才项目

项目编号：

20377798D361004

出版年：

2024

DOI：

10.3969/j.issn.2095-3097.2024.01.011

转化医学杂志

海军总医院

转化医学杂志

CSTPCD

影响因子：0.671

ISSN：2095-3097

年,卷(期)：2024.13(1)

参考文献量38