【摘要】 目的:分析经颈静脉肝内门体分流术(TIPS)患者的疗效及生存情况。方法:食管胃底静脉曲张破裂出血的患者分为药物保守治疗组(48例)和TIPS组(120例)。收集TIPS组患者的基本信息及临床资料、术后症状改善情况及并发症发生情况，药物保守治疗组患者再出血情况。分析TIPS术前后肝功能及凝血功能变化情况；分析TIPS术后△PPG及PPG下降幅度对术后发生肝性脑病及再出血的影响；分析不同支架对术后并发症发生的影响，比较两组患者再出血率的差异；分析1月、6月、1年、2年的累积生存率，比较两组患者生存率差异。结果:TIPS术后1月、6月、1年、2年患者的累积生存率明显高于药物保守治疗组(P均<0.05)。TIPS组患者术后再出血率明显低于药物保守治疗组(χ~2=44.92,P<0.05)。术后出现肝性脑病的患者28例(23.33%);出现感染5例(4.17%);食管胃底静脉曲张破裂再出血19例(15.83%);肝功能恶化38例(30%);腹腔出血2例(1.67%);异位栓塞1例(0.83%)。TIPS术后1周ALT、AST、TBil、PT均有上升(P<0.05),而Alb变化无统计学差异(P>0.05)。TIPS术后中位△PPG和PPG下降幅度百分比分别为13.4 mmHg、59.10%,但是△PPG和PPG下降幅度百分比对术后发生肝性脑病和再出血无影响(P>0.05)。术后出现肝性脑病、感染和再出血在不同支架[戈尔TIPS专用支架支架、组合支架(巴德金覆膜支架联合裸支架)]中无统计学差异(P>0.05)。结论:TIPS术对门静脉高压及其所致并发症的疗效显著，可明显改善食管胃静脉曲张破裂出血，提高生存率，但是术后发生肝性脑病仍是一个亟待解决的问题。更多还原

【Abstract】 Objective:To analyze the efficacy and survival of patients undergoing jugular intrahepatic portal shunt(TIPS) in Taihe Hospital of Shiyan City.Methods:Patients with esophageal and gastric varices rupture and bleeding who were hospitalized in The Department of Infectious Diseases, Taihe Hospital, Shiyan City from March 2017 to February 2022 were screened and divided into the conservative treatment group and TIPS group. A total of 120 patients received TIPS treatment, and 48 patients received conservative treatment. Basic information and clinical data(liver function and coagulation function), improvement of postoperative symptoms, and occurrence of complications(hepatic encephalopathy, esophageal and gastric variceal rupture and rebleeding, infection, and deterioration of liver function) in the TIPS group were collected, and rebleeding of patients in the conservative treatment group was collected. Wilcoxon sign rank test was used to analyze the changes in liver function and coagulation function before and after TIPS. Mann-whitney U method was used to analyze the effects of △PPG and the decrease of PPG after TIPS on postoperative hepatic encephalopathy and rebleeding. The χ~2 test was used to analyze the influence in different stents on postoperative complications, and the difference of rebleeding rate between the two groups was compared. Kaplan-meier method was used to analyze the cumulative survival at one month, six months, one year, and two years, and log-rank test was used to compare the difference in survival between the conservative treatment group and the TIPS group. Results:In this study, a total of 127 patients undergoing TIPS were screened, including three patients with surgical failure, two patients with liver cancer, and two patients with lost follow-up. A total of 120 patients were enrolled. The cumulative survival rate of TIPS patients at one month, six months, one year, and two years was significantly higher than that of the drug conservative treatment group, 96.7% vs. 81.3%, 92.8% vs. 79.0%, 91.5% vs. 76.4%, 85.9% vs. 73.3%(P<0.05). The postoperative rebleeding rate in TIPS group was significantly lower than that in conservative treatment group(χ~2=44.92,P>0.05).Postoperative hepatic encephalopathy occurred in 28 patients(23.33%). Five people(4.17%) were infected; Esophagealgastric fundus varices ruptured and rebleeding in 19 patients(15.83%); Liver function deteriorated in 38 patients(30%); There were two cases of abdominal bleeding(1.67%).Ectopic embolism occurred in one patient(0.83%). ALT, AST, TBil, and PT all increased one week after TIPS(P<0.05). The median decrease percentage of △PPG and PPG after TIPS was 13.4mmHg and 59.10%, respectively. However, △PPG and PPG decreased percentage had no effect on postoperative hepatic encephalopathy and rebleeding(P>0.05). There were no significant differences in postoperative hepatic encephalopathy, infection, and rebleeding among different stents(Gore TIPS special stents and combination stents(Badkin film coated stents combined with bare stents)(P>0.05). Conclusion:TIPS has significant efficacy in the treatment of portal hypertension and its complications, which can significantly improve the rupture and bleeding of esophageal and gastric varices and improve the survival rate. However, postoperative hepatic encephalopathy is still an urgent problem to be solved.更多还原