摘要
目的 经颈静脉肝内门体分流术(Transjugular Intrahepatic Portosytemic stent shunt,Tipss)治疗门脉高压症和消化道出血的临床疗效观察。方法 对7例肝硬化并发门脉高压症患者行Tipss,检测门脉压和门静脉及脾静脉内径的变化。结果 Tipss的成功率为85.7％(6/7),门脉压(cmH_2O)24.83±2.137(P<0.01,vs术前的43.33±2.733),提示Tipss能有效地降低门脉压;门静脉主干及脾静脉内径(cm)分别为0.98±0.098,0.80±0.064(P<0.01,vs术前的1.48±0.073,1.23±0.028),进一步说明了门脉压的降低。近期有效率及急症出血控制率为100％,肝性脑病的发生率为16.7％,其发生与分流的血管有关,左肝静脉与门脉左支分流者较右肝静脉与门脉右支及门脉主干分流者低。12月内支架狭窄、闭塞2例(2/4),18月内闭塞1例(1/2),发生再出血2例(2/6),随访6-24月无死亡。结论 Tipss是一种有效降低门脉压、控制食管、胃底静脉曲张破裂出血的新技术,对于急症出血的疗效优佳,但是,中远期分流道易发生狭窄和阻塞,其疗效有待进一步提高。
Objective To observe clinical effects with Transjugular Intrahepatic Portosystemic stent shunt(Tipss)in treating portal hypertension and digestive tract bleeding. Methods 7 patients of cirrhosis with portal hyperten-sion were treated by Tipss, portal pressure, internal diameter of protal and splenic veins were measured. ResultsShunt was successful in 6 of 7 patients (85.7%). Portal pressures before and after shunt were 43.33±2.733cmH_2O and 24.83±2.137 cmH_2O. Internal diameters of portal and splenic veins before and after shunt were con-tracted 1.48±0.073cm, 1.23±0.028cm and 0.98±0.098cm, 0.80±0.064cm. These data showed that portal pres-sure dropped obviously. The near future efficiency and the control rate of acute bleeding were 100%. The incidencerate of hepatic coma was 16.7%, which was possibly related to blood vessels of shunt. During 6～24 months of fol-lowing-up in 7 patients, none of them died and variceal re-bleeding occurred in 2 patients. 2 patients had shuntstenosis and occlusion in 12 months(2/4). 1 patient had occlusion in 18 months (1/2). Conclusion Tipss is a use-ful treatment for variceal bleeding and portal pressure dropping, especially for acute bleeding, but shunt stenosisand occlusion found in long-term follow-up occur frequently. The curative effects should be further improved.
关键词
肝硬化
门脉高压症
介入治疗
经颈静脉肝内门体分流术
疗效
并发症
Cirrhosis
portal hypertension
interventional therapy
Transjugular Intrahepatic Portosystemic stent shunt(Tipss)
