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目的:研究经颈静脉肝内门体分流术(TIPS)治疗肝硬化食管胃底静脉曲张破裂出血的疗效及安全性。方法:选取我院2013年8月到2015年4月收治的肝硬化食管胃底静脉曲张破裂出血患者86例为研究对象,采用随机数字法将其分为对照组和观察组,每组各43例。对照组患者行经皮经肝胃冠状静脉栓塞术(PTVE)治疗,观察组患者行TIPS治疗。比较两组患者的手术成功率、各并发症发生率、远期生存率及症状缓解情况,同时观察两组患者术后的肝功能变化。结果:观察组手术后的门静脉压力、术后3个月、6个月及12个月再出血发生率均明显低于对照组(P<0.05),而肝性脑病发生率与对照组比较差异无明显统计学意义(P>0.05)。两组手术前、术后6个月和12个月的Child-Pugh评分、血清TBIL、DBIL水平比较均无明显差异(P>0.05),术后3个月,观察组的Child-Pugh评分、血清TBIL、DBIL水平均明显高于对照组(P<0.01)。两组术后1年生存率比较无明显差异(P=0.72)。结论:TIPS治疗肝硬化食管胃底静脉曲张破裂出血的手术安全性较高,术后再出血等并发症发生率低,能有效改善静脉曲张症状,对肝功能损伤控制较好,且远期生存率较高。
Objective: To study the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of patients with esophageal variceal bleeding due to cirrhosis. Methods: Totally 86 patients with esophageal and gastric variceal bleeding in our hospital from August 2013 to April 2015 were enrolled in this study. They were divided into control group and observation group by random number method example. Patients in the control group underwent percutaneous transhepatic coronary vein thrombolysis (PTVE) and patients in the observation group underwent TIPS. The success rate of surgery, the incidence of complications, long-term survival and symptom relief were compared between the two groups. The changes of liver function in both groups were also observed. Results: The portal vein pressure in the observation group was significantly lower than that in the control group at 3 months, 6 months and 12 months after operation (P <0.05), while the incidence of hepatic encephalopathy was significantly lower than that in the control group No significant statistical significance (P> 0.05). Child-Pugh scores, serum TBIL and DBIL levels were not significantly different between the two groups before surgery, 6 months and 12 months after operation (P> 0.05). At 3 months after operation, the Child-Pugh scores, Serum TBIL and DBIL levels were significantly higher than the control group (P <0.01). The 1-year postoperative survival rate was no significant difference between the two groups (P = 0.72). Conclusion: TIPS is safe and safe in the treatment of esophagogastric variceal bleeding due to cirrhosis. The incidence of postoperative complications such as rebleeding is low, which can effectively improve the symptoms of varicose veins, control the damage of liver function, and long-term survival Higher rate.