【摘要】 目的　通过对照研究的方法 ,探讨经颈静脉肝内门体静脉支架分流术 (TIPSS)和食管静脉套扎术 (EVL)在治疗难治性或反复发作性食管静脉曲张破裂出血的疗效。方法　对 1 2例经胃镜确诊是食管静脉曲张破裂出血的患者行急诊或择期TIPSS治疗 ,并另选取 1 2例有相似病情和一般条件的患者 ,采取急诊或择期EVL治疗 ,比较两组患者在术后 2年随诊期内不同时间的死亡率、再出血率、肝功能和外周血小板的变化。结果　TIPSS组在术后 30d死亡率低于EVL组 (1 6 .67%vs 33 .33 % ) ,1年时 ,两组比较有显著差异 (1 6 .67%vs 41 .67% ) ,到 2年时 ,两组死亡率比较无显著差异 (50 0 0 %vs 58.33 % )。随诊期内 ,EVL组的再出血率要高于TIPSS组 (75 %vs 2 5 % )。与EVL组比较 ,TIPSS组术后肝功能有不同程度的下降。两组病人术后外周血的血小板计数无明显变化。结论　TIPSS治疗的近期疗效优于EVL治疗 ,中远期观察 ,两种方法似无差别。TIPSS组的病人术后主要死亡原因是肝功衰竭引发的肝肾综合征和严重的肝性脑病 ,EVL组患者的死亡原因与高再出血率密切相关更多还原

【Abstract】 Objective\ To explore effect of transjugular intrahepatic portosystemic stent shunt (TIPSS) and esophageal variceal ligation (EVL) in the treatment of patients with refractory or repeating esophageal variceal bleeding .Method\ 12 patients with esophageal variceal bleeding, confirmed by endoscopy were treated with emergency or selective TIPSS, and the other 12 patients with EVL treatment. The mortality, rate of rebleeding, serum albumin and bilirubin as well as platelets were followed for 2 years in both groups. Results\ 30 days after treatment, the mortality in TIPSS group was lower than that in EVL group (16.67% vs 33.33%), more significantly one year after treatment (16.67% vs 41.67% ). During the follow-up, the rate of rebleeding in the EVL group was much higher than that in the TIPSS group(75% vs 25%), while the liver function in TIPSS group was worse than that in EVL group. There were no difference in the number of periphral circulating platelet in the two groups. Conclusion\ The results suggest that the short term effect of TIPSS treatment is better than that of EVL treatment in patients with refractory or repeating esophageal variceal bleeding, but the long term effect in the two methods is supposed to be the same.更多还原