摘要目的：评价应用急诊经颈静脉肝内门体分流术（TIPS）治疗肝硬化门脉高压症所致的食管胃静脉曲张破裂出血（EGVB）患者的安全性及有效性。方法：回顾性分析14例于我院急诊行TIPS术治疗的EGVB患者的资料，观察术后止血情况、肝静脉压力梯度（HVPG）、肝功能、术后并发症、再出血情况及支架再闭塞情况等。计量资料采用配对t检验进行分析。结果：14例患者均成功完成急诊TIPS手术，围手术期无严重并发症发生。术中测量HVPG由术前（38.9±9.0） cm H2O降为术后（19.1±7.0） cm H2O，差异均有统计学意义，手术前后患者肝功能无明显差异。所有患者术后72 h内出血停止，手术止血率100%。随访3~12月，1例患者因消化道穿孔死亡，1例术后进行肝移植，其余12例状态良好，2例发生肝性脑病（2期），随访期内无患者出现再出血，应用超声及CT随访未发现支架阻塞。结论：对于急性EGVB的肝硬化门脉高压症患者，急诊TIPS治疗安全可行，疗效令人满意。
Abstract：Objective: To investigate the safety and efficacy of emergency transjugular intrahepatic portosystemic shunt(TIPS) in the treatment of esophageal and gastric variceal bleeding(EGVB) in liver cirrhosis and portal hypertension. Methods: The clinical data of 14 EVGB patients with liver cirrhosis and portal hypertension who undergoing emergency TIPS were retrospectively analyzed. The haemostasis, hepatic vein pressure gradient(HVPG), liver function, complications, rebleeding and in-stent occlusion were observed. The paired-samples t-test was performed for measurement data. Results: All emergency TIPS of the 14 patients were successful. There was no perioprative serious complication. The HVPG dropped from (38.9±9.0) cm H2O to (19.1±7.0) cm H2O(P<0.001). There was no significant difference in liver function between before and after operation. The bleeding stopped in 72 hours after operation in all patients． There was no rebleeding occurred during 3~12 months followed-up, one patient died of perforation of stomach, one patient underwent liver transplantation, and 2 patients had mild hepatic encephalopathy. There was none in-stent occlusion assessed by ultrasound and computed tomography during follwed-up. Conclusion: The emergency TIPS is safe and effective in the treatment of acute EGVB in cirrhotic patients with portal hypertension．
马羽佳，龚 正，迟 源，郑加贺，刘兆玉，郭启勇. 急诊经颈静脉肝内门体分流术治疗肝硬化静脉曲张出血的疗效评价[J]. 中国临床医学影像杂志, 2017, 28(12): 888-892.
MA Yu-jia, GONG Zheng, CHI Yuan, ZHENG Jia-he, LIU Zhao-yu, GUO Qi-yong. Evaluation of emergency transjugular intrahepatic portosystemic shunt in the treatment of variceal bleeding in liver cirrhosis. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(12): 888-892.
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