摘要
目的研究急诊经颈静脉肝内门体分流术(TIPS)联合食管胃底静脉曲张栓塞术(EGVE)治疗门静脉高压食管胃底静脉曲张破裂出血(EGVB)绿色通道建立的有效性。方法行TIPS联合EGVE治疗的32例门静脉高压EGVB患者选取急诊TIPS联合EGVE治疗(最近1次活动性大出血患者,24 h内接受TIPS联合EGVE紧急止血)的20例患者作为急诊组,取择期进行TIPS联合EGVE治疗的12例患者作为择期组。比较两组手术情况、治疗效果、7个月的随访结果(术后再出血、死亡及肝性脑病发生情况)、术后血氨水平以及治疗前后门静脉压力梯度(PPG)水平。结果手术于患者入院后2~12 h内实施,平均入院至开始手术时间(4.25±2.59)h;手术持续时间2~4 h,平均手术持续时间(2.75±1.15)h。32例患者手术均成功,门静脉穿刺点选取左支24例(75.00%)、右支8例(25.00%)。术前,择期组与急诊组PPG水平分别为(35.05±5.92)、(40.36±5.41)mm Hg(1 mm Hg=0.133 kPa);术后,择期组与急诊组PPG水平分别为(25.01±5.42)、(27.72±5.71)mm Hg。两组患者术后PPG水平均低于术前,差异均具有统计学意义(P<0.05)。两组死亡率、再出血率及肝性脑病发生率比较,差异均无统计学意义(P>0.05)。7例发生肝性脑病患者中,4例(57.14%)发生于术后1个月内,6例(85.71%)发生于术后6个月内。急诊组患者术前以及术后1、3、6个月的血氨水平均高于择期组,差异均具有统计学意义(P<0.05)。结论急诊行TIPS联合EGVE绿色通道建立治疗EGVB患者,有效性及安全性较高。
Objective To study the feasibility,safety and effectiveness of green channel establishment for the treatment of esophageal gastric variceal bleeding(EGVB)caused by portal hypertension with transjugular intrahepatic portosystemic shunt(TIPS)combined with esophageal and gastric variceal embolization(EGVE).Methods Of the 32 patients with EGVB caused by portal hypertension treated hy TIPS combined with EGVE,20 patients treated with emergency TIPS combined with EGVE(patients with recent active hemorrhage or patients received TIPS combined with EGVE within 24 h for emergency hemostasis)were selected as the emergency group,and 12 patients treated with elective TIPS combined with EGVE were selected as the elective group.Both groups were compared for surgical status,therapeutic effect,7-month follow-up results(postoperative rebleeding,death,and occurrence of hepatic enrephalopathy),postoperative blood ammonia levels,and portal pressure gradient(PPG)levels before and after treatment.Results The surgery was performed within 2-12 h after the patients were admitterl to the hospital,with a mean time from admission to the start of surgery of(4.25±2.59)h;the duration of surgery was 2-4 h,with a mean duration of surgery of(2.75±1.15)h.The surgery was successful in all 32 patients,and the portal vein puncture site was selected for the left branch in 24 cases(75.00%)and the right branch in 8 rases(25.00%).Before surgery,the PPG levels of the elective group and the emergency group were(35.05±5.92)and(40.36±5.41)mm Hg(1 mm Hg=0.133 kPa)respectively;after surgery,the PPG levels of the elective group and the emergency group were(25.01±5.42)and(27.72±5.71)mm Hg,respectively.The PPG levels of the two groups after surgery were lower than those of this group before surgery,and the differences were statistically significant(P<0.05).There was no statistically significant difference in mortality,rehleeding rate and incidence of hepatic encephalopathy between the two groups(P>0.05).Of the 7 patients who developed hepatic encephalopathy,4 cases(57.14%)occurred within 1 month after surgery,and 6 cases(85.71%)occurred within 6 months after surgery.The blood ammonia levels of the emergency group before surgery and 1,3,and 6 months after surgery were higher than those of the elective group,and the difference was statistically significant(P<0.05).Conclusion Green channel establishment for emergency TIPS combined with EGVB is effective and safe in the treatment of EGVB.
作者
杨立国
YANG Li-guo(Department of Intervention,Benxi Sixth People's Hospital,Benxi 117000,China)
出处
《中国实用医药》
2021年第33期12-14,共3页
China Practical Medicine
关键词
经颈静脉肝内门体分流术
食管胃底静脉曲张栓塞
门静脉高压食管胃底静脉曲张破裂出血
绿色通道
Transjugular intrahepatic portosystemic shunt
Esophageal and gastric variceal embolization
Esophageal gastric variceal bleeding caused by portal hypertension
Green channel
