摘要目的：评价经颈静脉肝内门体静脉分流术（TIPS）联合食管胃底曲张静脉栓塞术（SEVE）治疗门静脉高压胃底静脉曲张伴胃肾分流道直径≥5 mm患者的临床疗效和安全性。方法收集2013年10月至2014年12月的18例采用TIPS联合SEVE治疗门静脉高压胃底静脉曲张出血患者的病历资料。观察术前与术后的门静脉压力差、术前与术后的Child‐Pugh评分、术后24 h止血情况、支架通畅情况、肝性脑病发生情况、再出血情况、肝功能衰竭发生情况、死亡情况，以及肝功能、血小板减少的转归情况。计量资料比较行 t检验或方差分析。结果18例患者的平均门静脉压由术前的（34．23±6．35） cmH2O（1 cmH2O＝0．098 kPa）降至术后的（25．69±6．89） cmH2O ，差异有统计学意义（t＝7．572，P＜0．01），术前与术后门静脉压差为（8．54±4．79） cmH2O。18例患者中，无肝功能衰竭发生。10例急诊手术患者中，24 h内9例成功止血。所有患者均未发生相关手术操作并发症。18例患者在随访过程中，2例经胃镜证实有曲张静脉破裂出血，为再出血，1例出现支架狭窄堵塞，3例出现不同程度的肝性脑病，1例死亡。患者不同随访时间的Child‐Pugh评分、血氨、白蛋白、总胆红素、白细胞计数、血小板计数与术前相比，差异均无统计学意义（P均＞0．05）。结论 TIPS联合SEVE治疗胃底静脉曲张伴胃肾分流道直径≥5 mm患者，能有效控制出血，未发生异位栓塞。

abstractsObjective To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastroesophageal variceal embolization (SEVE) in the treatment of patients with gastroesophageal varices accompanied by a gastrorenal shunt with a diameter over 5 mm .Methods From October 2013 to December 2014 ,the clinical data of 18 patients with portal hypertension caused gastroesophageal variceal bleeding and treated by TIPS combined with SEVE were collected . The difference of portosystemic pressure gradient between before and after operation was observed ,and Child‐Pugh score before and after operation was also evaluated .The hemostasis in 24 hours ,TIPS patency ,the occurrence of hepatic encephalopathy(HE) ,rebleeding ,hepatic failure ,mortality and the change of liver function and thrombocytopenia were recorded after operation .Student′s t‐test or analysis of variance was performed for statistical analysis of measurement data .Results In the 18 patients ,the average portal vein pressure decreased from (34 .23 ± 6 .35) cmH2O (1 cmH2O= 0 .098 kPa) before operation to (25 .69 ± 6 .89) cmH2O after TIPS combined with SEVE ,and the difference was statistically significant (t=7 .572 , P<0 .01) .The difference of portal vein pressure before and after operation was (8 .54 ± 4 .79) cmH2O . No hepatic failure was observed in all 18 patients .Among 10 patients with emergency operation ,nine&nbsp;patients obtained successful hemostasis in 24 hours .No operation related complications were observed in all the patients .During the follow‐up period of 18 patients ,two patients had variceal rebleeding confirmed by endoscopy ;one patient had stent stenosis;three patients got HE and one patient died .At different follow‐up time point of patients ,there was no significant difference in Child‐Pugh score ,blood ammonia level ,albumin level ,bilirubin level ,white blood cell count and blood platelets count compared with those before operation (all P>0 .05) .Conclusion TIPS combined with SEVE in the treatment of patients with gastroesophageal varices accompanied by a gastrorenal shunt with a diameter over 5 mm could effectively control bleeding ,and no ectopic embolism happened .