TIPS versus transcatheter sclerotherapy for gastric varices
TIPS versus transcatheter sclerotherapy for gastric varices
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DOI：
10.2214/ajr.183.2.1830369
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发表时间：
2004-08-01
影响因子：
5
通讯作者：
Inoue, Y
中科院分区：
文献类型：
--
作者：
Ninoi, T;Nakamura, K;Inoue, Y
OBJECTIVE.本研究的目的是比较经颈静脉肝内门体分流术（TIPS）和经导管硬化治疗胃静脉曲张的疗效和长期结果。共139例胃底静脉曲张患者接受了血管内治疗。在139例患者中，104例无肝细胞癌患者入组; 27例患者接受TIPS治疗，77例患者接受经导管硬化治疗。比较TIPS组和经导管硬化治疗组的胃静脉曲张出血率和生存率。多因素分析用于确定胃静脉曲张出血和生存的预后因素。评价各组肝功能的变化。TIPS组和经导管硬化治疗组1年时累积胃静脉曲张出血率分别为20%和2%（p < 0.01）。与胃静脉曲张出血相关的预后因素是治疗方法。TIPS组1、3、5年的累积生存率分别为81%、64%、40%，经导管硬化治疗组分别为96%、83%、76%（p < 0.01）。生存的预后因素是治疗方法和肝脏疾病的Child-Pugh分级。对于Child-Pugh A级患者，经导管硬化治疗组的生存率高于TIPS组（p < 0.01）。对于Child-Pugh分级为B和C的患者，两组之间未见显著差异。经导管硬化治疗组肝功能有改善的趋势。经导管硬化疗法可能比TIPS更好地控制胃静脉曲张出血。在Child-Pugh A级疾病患者中，经导管硬化疗法可能比TIPS具有更高的生存率。
OBJECTIVE. The purpose of our study was to compare the efficacy and long-term results of transjugular intrahepatic portosystemic shunt (TIPS) with those of transcatheter sclerotherapy for the treatment of gastric varices.MATERIALS AND METHODS. A total of 139 cirrhotic patients with gastric varices underwent endovascular treatment. Of the 139 patients, 104 without hepatocellular carcinoma were enrolled; 27 patients were treated with TIPS, and 77 patients with transcatheter sclerotherapy. Bleeding of gastric varices and survival rates were compared between the TIPS and transcatheter sclerotherapy groups. Multivariate analysis was used to identify the prognostic factors for gastric variceal bleeding and survival. Changes in liver function were evaluated in each group.RESULTS. The cumulative gastric variceal bleeding rate at 1 year was 20% in the TIPS group and 2% in the transcatheter sclerotherapy group (p < 0.01). The prognostic factor associated with gastric variceal bleeding was the treatment method. The cumulative survival rates at 1, 3, and 5 years were, respectively, 81%, 64%, and 40% in the TIPS group and 96%, 83%, and 76% in the transcatheter sclerotherapy group (p < 0.01). The prognostic factors for survival were the treatment method and the Child-Pugh classification of liver disease. For patients categorized in Child-Pugh class A, the survival rate was higher in the transcatheter sclerotherapy group than in the TIPS group (p < 0.01). For patients in Child-Pugh classes B and C, no significant difference was seen between the two groups. Liver function tended to improve in the transcatheter sclerotherapy group.CONCLUSION. Transcatheter sclerotherapy may provide better control of gastric variceal bleeding than TIPS. Transcatheter sclerotherapy may contribute to a higher survival rate than TIPS in patients with Child-Pugh class A disease.