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目的分析经颈静脉肝内门体静脉分流术(transjugular intrahepatic porto-systemic shunt,TIPS)与食管胃曲张静脉栓塞术联合应用治疗肝硬化门静脉高压合并食管胃静脉曲张破裂出血的临床疗效及安全性。方法对2009年10月—2012年10月临床收治的299例肝硬化门静脉高压合并食管胃静脉曲张破裂出血患者行TIPS与食管胃曲张静脉栓塞术联合治疗,测量患者栓塞前后和支架置入前后门静脉压力。观察和统计术后再出血率、分流道再狭窄率和肝性脑病发生率。结果完成TIPS与曲张静脉栓塞术联合手术297例,成功率为99.3%。297例均在术后随访3年,术后1、2、3年再出血率分别为4.7%、11.1%和19.2%;3年分流道累计狭窄率为19.5%。结论 TIPS与曲张静脉栓塞术联合应用是治疗门脉高压食管胃底静脉曲张破裂出血的最佳治疗方法,弥补了二种技术单独临床应用的不足,而且并不增加行TIPS的复杂性和风险。
Objective To analyze the clinical efficacy and safety of transjugular intrahepatic porto-systemic shunt (TIPS) combined with transesophageal variceal embolization in the treatment of portal hypertension with cirrhosis and esophagogastric variceal bleeding. Methods From October 2009 to October 2012, 299 patients with cirrhosis complicated with portal hypertension and esophagogastric variceal bleeding were treated with TIPS combined with esophageal variceal embolization. Before and after embolization and before and after stent implantation pressure. Observed and statistical postoperative hemorrhage rate, shunt restenosis and hepatic encephalopathy incidence. Results 297 TIPS and varicose vein embolization combined surgery, the success rate was 99.3%. All 297 patients were followed up for 3 years. The rates of rebleeding at 1, 2 and 3 years after operation were 4.7%, 11.1% and 19.2% respectively. The cumulative stenosis rate in 19 cases was 3 years. Conclusion The combination of TIPS and varicose vein embolization is the best treatment for esophagogastric variceal bleeding in patients with portal hypertension, which can make up for the shortcomings of the two technologies in clinical application alone without increasing the complexity and risk of TIPS.