经颈静脉肝内门体分流术和胃冠状静脉栓塞术治疗肝硬化门静脉高压症食管胃静脉曲张出血的结果。
Outcomes of Transjugular Intrahepatic Portosystemic Shunt and Gastric Coronary Vein Embolization for Variceal Bleeding in Cirrhotic Portal Hypertension.
机构信息
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
出版信息
Clin Med Res. 2023 Sep;21(3):144-154. doi: 10.3121/cmr.2023.1796.
To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization (GCVE) for cirrhotic portal hypertensive variceal bleeding and compare outcomes of first-line with second-line treatment, coil with glue, and single-covered with double stents. Fifteen patients received TIPS plus GCVE as the first-line treatment for secondary prophylaxis of variceal bleeding, and 45 received it as second-line treatment. Preoperative and postoperative quantitative variables were compared using a paired t test. The incidence of survival rate, re-bleeding, hepatic encephalopathy, and shunt dysfunction were analyzed using the Kaplan-Meier method. The portal venous pressure was significantly decreased from 39.0 ± 5.0 mm Hg to 22.5 ± 4.4 mm Hg (≤0.001) after TIPS treatment. After 1, 3, 6, 12, 18, and 24 months re-bleeding rates were 1.6%, 3.3%, 6.6%, 13.3%, 0%, and 0%, respectively. Shunt dysfunction rates were 5%, 0%, 10%, 16.6%, 1.6%, and 5%, respectively. Hepatic encephalopathy rates were 3.3%, 1.6%, 3.3%, 6.6%, 0%, and 0%, respectively. And survival rates were 100%, 100%, 100%, 96.6%, 93.3%, and 88.3% respectively. In comparative analysis, statistically significant differences were seen in re-bleeding between the first-line and second-line treatment groups (26.6% vs 24.4%, log-rank =0.012), and survival rates between single-covered and double stent (3.7% vs 16.1%, log-rang (=0.043). The results suggest that TIPS combined with GCVE is effective and safer in the treatment of cirrhotic portal hypertensive variceal bleeding. The use of TIP plus GCVE as first-line treatment, may be preferable for high-risk re-bleeding, and more than 25 mm Hg portal venous pressure with repeated variceal bleeding. However, the sample size was small. Therefore, large, randomized, controlled, multidisciplinary center studies are needed for further evaluation.
为了评估经颈静脉肝内门体分流术（TIPS）联合胃冠状静脉栓塞术（GCVE）治疗肝硬化门静脉高压性静脉曲张出血的疗效和安全性，并比较一线治疗、线圈与胶、单支架与双支架的治疗结果，我们对 15 例患者进行了 TIPS 联合 GCVE 作为静脉曲张出血二级预防的一线治疗，并对 45 例患者进行了二线治疗。采用配对 t 检验比较术前和术后的定量变量。采用 Kaplan-Meier 法分析生存率、再出血、肝性脑病和分流功能障碍的发生率。TIPS 治疗后门静脉压力从 39.0±5.0mmHg 显著降低至 22.5±4.4mmHg（≤0.001）。1、3、6、12、18 和 24 个月后再出血率分别为 1.6%、3.3%、6.6%、13.3%、0%和 0%。分流功能障碍率分别为 5%、0%、10%、16.6%、1.6%和 5%。肝性脑病发生率分别为 3.3%、1.6%、3.3%、6.6%、0%和 0%。生存率分别为 100%、100%、100%、96.6%、93.3%和 88.3%。在对比分析中，我们发现一线治疗和二线治疗组的再出血率（26.6%比 24.4%，log-rank=0.012）和单支架与双支架组的生存率（3.7%比 16.1%，log-rang=0.043）之间有统计学差异。结果表明，TIPS 联合 GCVE 治疗肝硬化门静脉高压性静脉曲张出血有效且安全。对于高危再出血和反复静脉曲张出血伴门静脉压力超过 25mmHg 的患者，使用 TIPS 联合 GCVE 作为一线治疗可能更优。但是，样本量较小。因此，需要进行更大规模、随机、对照、多学科中心的研究来进一步评估。
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