[1]毕光荣,张 勇,陈旭昇.经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗门脉高压上消化道出血的临床疗效[J].介入放射学杂志,2013,(03):239-243.
 BI Guang? rong,ZHANG Yong,CHEN Xu? sheng..The clinical efficacy of transjugular intrahepatic portosystemic shunt combined with gastric coronary vein embolization for portal hypertension complicated by upper gastrointestinal bleeding[J].journal interventional radiology,2013,(03):239-243.
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经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗门脉高压上消化道出血的临床疗效()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2013年03期
页码:
239-243
栏目:
临床研究
出版日期:
2013-03-25

文章信息/Info

Title:
The clinical efficacy of transjugular intrahepatic portosystemic shunt combined with gastric coronary vein embolization for portal hypertension complicated by upper gastrointestinal bleeding
作者:
毕光荣 张 勇 陈旭昇
Author(s):
BI Guang?蛳 rong ZHANG Yong CHEN Xu?蛳 sheng.
Department of Radiology, the First People’s Hospital and Renji Medical Center, Zigong, Sichuan Province 643000, China
关键词:
【关键词】 上消化道出血 经颈静脉肝内门体分流术 食管胃底静脉曲张栓塞术 肝硬化门静脉高压 肝昏迷
文献标志码:
A
摘要:
【摘要】 目的 评价经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)治疗肝硬化门脉高压上消化道出血的应用价值。方法 对54例肝硬化门静脉高压上消化道出血患者行TIPS联合 GCVE术治疗,术前Child?蛳 Pugh评分A级16例,B级28例,C级10例,术后对其临床疗效、并发症、肝肾功能变化等进行随访观察,连续随访9 ~ 42个月。结果 54例均手术成功并有效止血,门脉压力明显降低,术后3 d、1周及1个月患者的丙氨酸转氨酶(ALT),天冬氨酸转氨酶(AST),总胆红素(TBIL)、直接胆红素(DBIL)均有一定程度上升, 在半年后降至术前水平。血尿素氮(BUN)、肌酐(Cr)在术后1周即有显著下降(P < 0.05),至半年随访亦有下降趋势。术后1、6个月,1、2和3年再出血率分别为0,3.7%,9.3%,14.8%,20.4%,支架累计狭窄率为27.8%,肝性脑病发生率为24.1%。随访期间共死亡7例,2例死于原发性肝癌,4例死于消化道大出血,1例死于多器官功能衰竭。结论 TIPS联合GCVE治疗门静脉高压上消化道出血,疗效肯定,再出血率低、可重复操作,是一种安全、有效的治疗方法。

参考文献/References:

[1] 徐 克, 腾皋军. Abrams 介入放射学[M]. 北京: 人民卫生出版社, 2010: 512 ?蛳 523.[2] 原姗姗, 韩国宏, 樊代明. TIPS治疗门静脉高压并发症预后评价的现状[J]. 介入放射学杂志, 2011, 20: 245 ?蛳 248.[3] 蒋明德, 秦建平. TIPS的临床应用再评价[J]. 世界华人消化杂志, 2003, 11: 1989 ?蛳 1992.[4] 李京雨, 徐力扬, 张 强, 等. 肝血管性疾病门静脉高压的介入性诊断与治疗[J]. 临床肝胆病杂志, 2011, 27: 643 ?蛳 646.[5] 张金山, 王茂强, 杨 立, 等. 经颈静脉肝内门腔静脉内支架分流术的临床应用(附80例随访分析)[J]. 中华放射学杂志, 1994, 28: 800 ?蛳 807.[6] Deleve LD, Valla DC, Garcia?蛳 Tsao G, et al. Vascular disorders of the liver[J]. Hepatology, 2009, 49: 1729 ?蛳 1764.[7] Boyer TD, Haskal ZJ, American Association for the Study of Liver Diseases. The role of transjugular intrahepatic portosyste?蛳 mic shunt (TIPS) in the management of portal hypertension: update 2009[J]. Hepatology, 2010, 51: 306.[8] Tesdal IK, Filser T, Weiss C, et al. Transjugular intrahepatic portosystemic shunts: adjunctive embolotherapy of gastroesopha?蛳 geal collateral vessels in the prevention of variceal rebleeding[J]. Radiology, 2005, 236: 360 ?蛳 367.[9] 胥 莹, 李迎春, 郭 涛, 等. 肝硬TIPS患者术后再出血分析[J]. 胃肠病学杂志, 2011,16: 551 ?蛳 553.[10] 唐承薇, 李 肖. 肝硬化门静脉高压治疗策略[J]. 中国实用内科杂志, 2011, 31: 79 ?蛳 80.[11] 李常青, 许东海, 徐道振, 等. 门静脉穿刺造影改良经颈静脉肝内门体分流术治疗门静脉高压上消化道出血[J]. 中华肝脏病杂志, 2005, 13: 403 ?蛳 406.[12] Gaba RC, Khiatani VL, Knuttinen MG, et al. Comprehensive review of TIPS technical complications and how to avoid them[J]. Am J Roentgenol, 2011, 196: 675 ?蛳 685.[13] 李灵敏, 肖天利, 廖化禹, 等. 经颈静脉肝内门体分流术对进展期肝硬化患者肝功能影响[J]. 第三军医大学学报, 2010, 32: 2235 ?蛳 2238.

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备注/Memo

备注/Memo:
(收稿日期:2012-09-08)
更新日期/Last Update: