经颈静脉肝内门体分流术联合胃冠状静脉栓塞治疗门脉高压并发上消化道出血效果观察

Effect of Transjugular Intrahepatic Portosystemic Shunt Combined with Gastric Coronary Venous Embolization for Portal Hypertension and Upper Gastrointestinal Bleeding

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(GCVE)治疗肝硬化门脉高压并发上消化道出血的临床疗效。方法：筛选2015年1月至2018年1月我院收治的肝硬化门脉高压并发上消化道出血患者142例，作为研究对象。根据患者治疗方案将其分为观察组与对照组，其中观察组80例患者接受TIPS治疗及GCVE，对照组62例患者接受常规药物治疗、局部压迫以及内镜下止血治疗，比较两组患者临床疗效及预后结局。结果：观察组患者治疗后消化道出血率明显低于对照组，P < 0.05，具有统计学意义；并且两组患者ALB、PALB水平比较无显著差异，P > 0.05；观察组患者治疗后肝性脑病发生率明显低于对照组，P < 0.05，差异具有统计学意义。结论：TIPS联合GCVE治疗肝硬化门脉高压并发上消化道出血疗效确切，可有效改善患者门脉高压及扩张症状，并且支架狭窄发生率较低，手术安全性较高，具有临床应用及推广价值。

Abstract: Objective: To investigate the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary venous embolization (GCVE) in the treatment of cirrhotic portal hypertension complicated with upper gastrointestinal bleeding. Methods: A total of 142 patients with cirrhotic portal hypertension complicated with upper gastrointestinal bleeding admitted to our hospital from January 2015 to January 2018 were selected as subjects. According to the patient’s treatment plan, they were divided into observation group and control group. Among them, 80 patients in the observation group received TIPS and GCVE, and 62 patients in the control group received conventional drug therapy, local compression and endoscopic hemostasis. Efficacy and prognosis outcomes were compared. Results: The gastrointestinal bleeding rate of the observation group was significantly lower than that of the control group, P < 0.05, which was statistically significant. There was no significant difference in ALB and PALB levels between the two groups (P > 0.05). The incidence of encephalopathy was significantly lower than that of the control group, P < 0.05, and the difference was statistically significant. Conclusion: TIPS combined with GCVE in the treatment of cirrhotic portal hypertension complicated with upper gastrointestinal bleeding is effective, can effectively improve the portal hypertension and dilatation symptoms, and the inci-dence of stent stenosis is low, the safety of surgery is high, and it has clinical application and pro-motion value.