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目的比较经颈静脉肝内门体分流术(TIPS)与药物联合内镜套扎术预防门脉高压症食管胃底静脉曲张出血(EGVB)的效果,探讨最佳的二级预防方案。方法将2011年1月至2014年5月住院并接受治疗的80例EGVB患者随机分成TIPS组和联合组,各40例,其中TIPS组接收TIPS治疗,而联合组接收药物联合内镜术治疗。随访截止时间为2016年6月,采用直接计算法计算两组患者治疗后的再出血率、生存率、肝性脑病发生率、分流道失效率及效费比,并进行组间比较。结果所有患者术后均成功止血。TIPS组患者的1年和2年再出血率(10.00%和15.79%)明显低于联合组的37.50%和42.86%(P<0.01,P<0.05);1年和2年生存率(95.00%和78.95%)明显高于联合组的70.00%和46.43%(P均<0.01);1年和2年肝性脑病发生率(20.00%和23.68%)与联合组的25.00%和35.71%比较差异无统计学意义(P均>0.05)。在随访期内,TIPS组的1年和2年分流道失效率分别为15.00%和28.95%,处于较低水平。TIPS组治疗2年时的效费比为5.91,联合组为4.57,TIPS组优于联合组。结论与药物联合内镜套扎术比较,早期应用TIPS可以提高EGVB患者的再出血控制率、生存率和效费比,且具有较好的安全性和实用性,可作为EGVB的首选治疗和二级预防方案。
Objective To compare the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) and drug-assisted endoscopic ligation in preventing portal hypertension varicocele (EGVB) and to explore the best secondary prevention strategy. Methods 80 patients with EGVB hospitalized and treated from January 2011 to May 2014 were randomly divided into TIPS group and combination group, 40 cases in each group. The TIPS group received TIPS treatment, while the combined group received drug combined with endoscopic treatment. The deadline for follow-up was June 2016. The direct calculation method was used to calculate the rates of rebleeding, survival, incidence of hepatic encephalopathy, shunt failure rate and cost-effectiveness ratio after treatment in both groups and compared among groups. Results All patients had successful hemostasis after operation. The 1-year and 2-year rates of rebleeding (10.00% and 15.79%) in the TIPS group were significantly lower than those in the combined group (37.50% vs. 42.86%, P <0.01, P <0.05) And 78.95% respectively) were significantly higher than 70.00% and 46.43% in the combined group (P <0.01). The incidence rates of hepatic encephalopathy at 1 year and 2 years (20.00% and 23.68%) were significantly different from those of the combined group at 25.00% and 35.71% No statistical significance (P> 0.05). During the follow-up period, the one-year and two-year failure rates in TIPS group were 15.00% and 28.95%, respectively, which were at a low level. In the TIPS group, the cost-effectiveness ratio was 5.91 at 2 years and 4.57 in the combination group, which was superior to the combination group in the TIPS group. Conclusion Compared with the drug endoscopic ligation, the early application of TIPS can improve the rebleeding control rate, survival rate and cost-effectiveness ratio in patients with EGVB, and has good safety and practicability, which can be used as the first choice for treatment of EGVB and two Prevention program.