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性静脉曲张破裂出血的疗效和安全性,并比较一线与二线治疗的疗效。带胶线圈,和单覆盖双支架。方法:15例患者接受TIPS加GCVE作为二级预防静脉曲张破裂出血的一线治疗,45人接受了二线治疗。术前和术后的定量变量使用配对t检验进行比较。生存率的发生率,再次出血,肝性脑病,和分流功能障碍采用Kaplan-Meier法进行分析。结果:经TIPS治疗后,门静脉压从39.0±5.0mmHg明显降低至22.5±4.4mmHg(P≤0.001)。术后1、3、6、12、18和24个月再出血率为1.6%,3.3%,6.6%,13.3%,0%,0%,分别。分流功能障碍率为5%,0%,10%,16.6%,1.6%,5%,分别。肝性脑病发生率为3.3%,1.6%,3.3%,6.6%,0%,0%,分别。生存率是100%,100%,100%,96.6%,93.3%,分别为88.3%。在比较分析中,一线和二线治疗组的再出血差异有统计学意义(26.6%vs24.4%,对数秩P=0.012),单支架和双支架之间的生存率(3.7%vs16.1%,对数范围(P=0.043)。结论:TIPS联合GCVE治疗肝硬化门脉高压性静脉曲张破裂出血疗效确切,安全性高。使用TIP加GCVE作为一线治疗,对于高风险的再出血可能更可取,门静脉压超过25mmHg,反复静脉曲张破裂出血。然而,样本量很小。因此,大,随机化,控制,多学科中心研究需要进一步评估。
Purpose: 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.Methods: 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.Results: The portal venous pressure was significantly decreased from 39.0 ± 5.0 mm Hg to 22.5 ± 4.4 mm Hg (P≤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 P=0.012), and survival rates between single-covered and double stent (3.7% vs 16.1%, log-rang (P=0.043).Conclusion: 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.