经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗乙型肝炎肝硬化并发食管胃静脉曲张患者效果分析*

doi:10.3969/j.issn.1672-5069.2022.06.024

实用肝脏病杂志 ›› 2022, Vol. 25 ›› Issue (6): 853-856.doi: 10.3969/j.issn.1672-5069.2022.06.024

经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗乙型肝炎肝硬化并发食管胃静脉曲张患者效果分析^*

孙静, 张伟伟, 马智勇, 代树本, 邓彦东

061001 河北省沧州市第三医院功能科(孙静,张伟伟,马智勇,代树本);河北医科大学第一医院超声科(邓彦东)

收稿日期:2022-05-07 出版日期:2022-11-10 发布日期:2022-11-22
作者简介:孙静,女,38岁,大学本科,主治医师。E-mail:cuidf_1979@163.com
基金资助:
^*沧州市重点研发计划指导项目(编号:204106013)

Prevention of varices re-bleeding in patients with liver cirrhosis undergoing transjugular intrahepatic portosystemie stent and gastric coronary vein embolization

Sun Jing, Zhang Weiwei, Ma Zhiyong, et al.

Functional Department, Third People’s Hospital, Cangzhou 061001, Hebei Province, China

Received:2022-05-07 Online:2022-11-10 Published:2022-11-22

摘要/Abstract

摘要： 目的探讨经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)治疗肝硬化并发食管胃静脉曲张(EV)患者的效果。方法 2018年1月～2020年12月我院收治的乙型肝炎肝硬化并发EV患者62例,其中33例(A组)接受TIPS联合GCVE治疗,29例接受TIPS联合食管静脉曲张套扎术(EVL)治疗,随访12个月。使用超声检测门静脉血流速度(PVFV)、门静脉压力(PVP)和门静脉压力梯度(PPG)。结果在术后1个月,A组PVFV为(15.9±1.8)cm/s,显著快于B组【(14.1±1.9)cm/s,P＜0.05】,PVP和PPG分别为(20.3±2.7)mmHg和(9.7±1.2)mmHg,显著低于B组【分别为(22.8±2.9)mmHg和(11.4±0.9)mmHg,P＜0.05】;在术后12个月,A组曲张静脉再出血发生率为6.0%,显著低于B组的31.0%(P＜0.05),而分流道畅通和肝性脑病发生率分别为93.9%和9.1%,与B组的93.1%和6.9%比,无统计学差异(P>0.05);A组病死率为15.1%,显著低于B组的41.3%(P＜0.05)。结论采用TIPS联合GCVE治疗肝硬化并发EV患者疗效确切,可有效提高门静脉血流速度,降低EV再出血发生率,提高生存率。

关键词: 肝硬化, 食管胃静脉曲张, 经颈静脉肝内门体分流术, 胃冠状静脉栓塞术, 治疗

Abstract: Objective The aim of this study was to observe the efficacy of transjugular intrahepatic portosystemie stent (TIPS) and gastric coronary vein embolization (GCVE) in treatment of patients with liver cirrhosis and esophageal varices (EV). Methods 62 patients with decompensated cirrhosis were encountered in our hospital between January 2018 and December 2020, and 33 patients in group A underwent TIPS and GCVE and 29 patients in group B underwent TIPS and endoscopic esophageal varices ligation (EVL). The portal vein blood flow velocity (PVFV), portal venous pressure (PVP) and portal vein pressure gradient (PPG) were detected by ultrasonography. Results At the end of one month after surgery, the PVFV in group A was (15.9±1.8)cm/s, significantly more rapid than [(14.1±1.9)cm/s, P＜0.05] in group B, while the PVP and PPG were (20.3±2.7)mmHg and (9.7±1.2)mmHg, significantly lower than [(22.8±2.9)mmHg and (11.4±0.9)mmHg, respectively, P＜0.05] in group B; at the end of twelve month, the incidence of EV re-bleeding in group A was 6.0%, significantly lower than 31.0%(P＜0.05) in group B, while there were no significant differences as respect to incidences of shunt patency and hepatic encephalopathy (93.9% and 9.1% vs. 93.1% and 6.9%, P>0.05) between the two groups; the fatality in group A was 15.1%, significantly lower than 41.3%(P＜0.05) in group B. Conclusion The efficacy of TIPS and GCVE in dealing with patients with liver cirrhosis and EV is efficacious, which might accelerate the blood flow velocity of portal vein, reduce re-bleeding and improve survivals.

Key words: Liver cirrhosis, Esophageal varices, Transjugular intrahepatic portosystemie stent, Gastric coronary vein embolization, Therapy

孙静, 张伟伟, 马智勇, 代树本, 邓彦东. 经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗乙型肝炎肝硬化并发食管胃静脉曲张患者效果分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 853-856.

Sun Jing, Zhang Weiwei, Ma Zhiyong, et al.. Prevention of varices re-bleeding in patients with liver cirrhosis undergoing transjugular intrahepatic portosystemie stent and gastric coronary vein embolization[J]. Journal of Practical Hepatology, 2022, 25(6): 853-856.

参考文献

[1] Gines P, Krag A, Abraldes JG, et al. Liver cirrhosis. Lancet, 2021,398(103):1359-1376.
[2] Williams EJ, Iredale JP, Williams EJ, et al. Liver cirrhosis. Postgrad Med J, 1998,74(870):193-202.
[3] Intagliata NM, Caldwell SH, Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology, 2019,156(6):1582-1599.
[4] Wei B, Huang Z, Tang C. Optimal treatment for patients with cavernous transformation of the portal vein. Front Med (Lausanne), 2022,24(9):853-855.
[5] Shen Y, Ma W, Hang Y, et al. Clinical application of liver stiffness measurement in patients with cavernous transformation of portal vein. Exp Ther Med, 2021,21(5):442-443.
[6] Tripathi D, Stanley AJ, Hayes PC, et al. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension. Gut, 2020,69(7):1173-1192.
[7] Hayashi T, Watanabe T, Shibata M, et al. Endoscopic injection sclerotherapy improves liver function compared with endoscopic variceal ligation. Sci Rep, 2021,11(1):2047-2049.
[8] Li Y, Cai BS, Li X, et al. Treatment of upper gastrointestinal bleeding by percutaneous transsplenic varices embolization in chronic hepatic schistosomiasis japonicum patients. Am J Trop Med Hyg, 2021,105(4):1109-1113.
[9] 中华医学会消化病学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治共识. 中华肝脏病杂志, 2008, 16(8):564-570.
[10] Stotts MJ, Lisman T, Intagliata NM. The spectrum of disease severity in cirrhosis and its implications for hemostasis. Semin Thromb Hemost, 2020,46(6):716-723.
[11] Tang R, Lu Q. Portal vein cavernous transformation at bilioenteric anastomosis. Hepatobiliary Surg Nutr, 2020,9(3):397-398.
[12] Zhang JB, Chen J, Zhou J, et al. Systematic review and meta-analysis of trans-jugular intrahepatic portosystemic shunt for cirrhotic patients with portal vein thrombosis. World J Clin Cases, 2021,9(19):5179-5190.
[13] Zhao M, Wang X, Liu B, et al. Transjugular intrahepatic portosystemic shunt for the treatment of portal hypertensive biliopathy with cavernous transformation of the portal vein: a case report. BMC Gastroenterol, 2022,22(1):96-98.
[14] Addeo P, Schaaf C, Faitot F, et al. Misplacement of transjugular intrahepatic portosystemic shunts: A surgical challenge for liver transplantation? Surgery, 2021,169(2):447-454.
[15] Basthi Mohan P, Nagaraju SP, Rangaswamy D, et al. Urinary neutrophil gelatinase-associated lipocalin: acute kidney injury in liver cirrhosis. Clin Chim Acta, 2021,5(23):339-347.
[16] Yao X, Zhou H, Huang S, et al. Effects of transjugular intrahepatic portosystemic shunt using the Viatorr stent on hepatic reserve function in patients with cirrhosis. World J Clin Cases, 2021,9(7):1532-1542.
[17] Perello MP, Mur JP, Vives MS, et al. Long-term follow-up of transjugular intrahepatic portosystemic shunt (TIPS) with stent-graft. Diagn Interv Radiol, 2019,25(5):346-352.
[18] 郭芳芳, 吴正阳, 周朋利,等. 经颈静脉肝内门体分流术治疗门静脉海绵样变并发食管胃底静脉出血价值分析. 中华医学杂志,2020,100(5):387-390.
[19] Khan F, Tripathi D. Role of early transjugular intrahepatic portosystemic stent-shunt in acute variceal bleeding: An update of the evidence and future directions. World J Gastroenterol, 2021,27(44):7612-7624.
[20] Boike JR, Flamm SL. Transjugular intrahepatic portosystemic shunts: Advances and new uses in patients with chronic liver disease. Clin Liver Dis, 2020,24(3):373-388.

经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗乙型肝炎肝硬化并发食管胃静脉曲张患者效果分析^*

Prevention of varices re-bleeding in patients with liver cirrhosis undergoing transjugular intrahepatic portosystemie stent and gastric coronary vein embolization

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	韩涛, 刘艳迪, 胡家轩. 肝病合并肾损伤临床诊治新进展[J]. 实用肝脏病杂志, 2022, 25(6): 761-763.
[2]	蒋莹莹, 丁惠国. 肝硬化并发急性肾损伤临床管理现状与挑战[J]. 实用肝脏病杂志, 2022, 25(6): 764-767.
[3]	韩芳, 李佳峥, 南月敏. 肝硬化并发急性肾损伤诊治进展[J]. 实用肝脏病杂志, 2022, 25(6): 768-771.
[4]	李向阳, 丁光伟, 靳铭. 恩替卡韦治疗慢性乙型肝炎合并NAFLD患者临床疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 776-779.
[5]	吴凤萍, 崔丹丹, 王怡恺, 李梅, 刘晨瑞, 南希, 贾晓黎, 党双锁. 血清BAFF预测聚乙二醇干扰素-α治疗非活动性HBsAg携带者临床治愈的效能分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 780-783.
[6]	许海玲, 秦刚, 薛红, 章颖. 艾尔巴韦/格拉瑞韦治疗基因1b型慢性丙型肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 788-791.
[7]	赵资德, 吴令杰, 张海生, 陈瑞烈. 纠正低蛋白血症减少抗结核药物性肝损伤发生临床研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 792-795.
[8]	孙峥, 王笑烨, 袁景, 梁丽. 达格列净联合利拉鲁肽治疗非酒精性脂肪性肝病合并2型糖尿病患者短期疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 796-799.
[9]	孙凌, 杭玮, 邓国忠. 二甲双胍联合吡格列酮治疗非酒精性脂肪性肝病合并2型糖尿病患者疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 804-807.
[10]	贺锦帆, 姚佳, 赵强, 王娟, 白津佳, 赵凝慧. 双重血浆分子吸附系统治疗肝衰竭患者发生血管迷走神经反应相关因素分析及其处理对策研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 828-831.
[11]	沈亦亮, 沈冬元, 陈永莹, 江凯, 朱逸明, 葛尚. 肝硬化患者肝内LR-3类结节恶变风险评估及预测模型的建立^*[J]. 实用肝脏病杂志, 2022, 25(6): 836-839.
[12]	徐超, 李兰, 罗东, 赵海云, 彭飞. TIPS术治疗的肝硬化并发EVB患者医院内死亡风险预测模型的构建与应用^*[J]. 实用肝脏病杂志, 2022, 25(6): 840-843.
[13]	林秀慧, 李南, 张娇珍, 符庆忠, 林秀华. 慢性HBV感染者外周血PNPLA3/PRKAA1基因多态性与肝硬化发生关系研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 844-847.
[14]	朱海艳, 范晓棠. 肝硬化并发门静脉血栓形成患者列线图预测模型分析及外部验证[J]. 实用肝脏病杂志, 2022, 25(6): 848-852.
[15]	李响, 张铁英, 张旭辉, 孟繁坤. 基于超声参数的半定量评分评估乙型肝炎肝硬化食管静脉曲张价值探讨^*[J]. 实用肝脏病杂志, 2022, 25(6): 857-860.