经颈静脉肝内门腔静脉内支架分流术的临床应用（附86例随访分析）  

Transjugular Intrahepatic Portosystemic Stent Shunt:Results in 86 Patients

作　　者：张金山[1] 王茂强[1] 杨立[1] 于淼[1] 黄英才[1] 崔志鹏[1] 邢冲冲[1] 程凤歧[1] 张政友 

机构地区：[1]中国人民解放军总医院放射科

出　　处：《中华放射学杂志》1994年第12期800-807,共8页Chinese Journal of Radiology

摘　　要：报告８６例经颈静脉肝内门腔静脉内支架分流术（ＴＩＰＳＳ）的临床应用结果，主要探讨与建立分流道有关的技术问题和影响疗效的因素。８６例中男６８例，女１８例，年龄２２～７４岁（平均４８岁），７１例有明确的乙型肝炎病史，６９例有一次以上呕血或黑便史，５８例曾接受一次以上经内镜注射硬化剂治疗，６例因大出血不止行急诊ＴＩＰＳＳ。全部病例有中度以上食管胃底静脉曲张。结果：７８例成功，８例失败，无死亡并发症。建立分流后门脉压从术前的４０．５±３．０ｃｍＨ＿２Ｏ＝（１ｃｍＨ＿２Ｏ＝０．０９８ｋＰａ）降至２４．０±３．５ｃｍＨ＿２Ｏ，Ｄｏｐｐｌｅｒ超声显示门脉主干血流速度从术前１２．０＋±．５ｃｍ／ｓ增至４８．５±１４．５ｃｍ／ｓ。术后随访观察２～１６个月（平均８个月），分流道早闭２例，３例术后２个月死于其他原因，７例失去联系，其余６６例有定期随访记录，其中３６例随访在６个月以上。术后半年内复发出血６例，经造影证实为分流道狭窄２例（经再通成功）、阻塞２例，１例内镜检查仍见重度静脉曲张，未行进一步检查，１例为非静脉曲张性出血；静脉曲张消失或减轻后再次出现３例，发生于术后４～７个月，超声波检查均提示分流道狭窄，２例造影证实分流道狭?The authors retrospectively analyzed 86 cases of TIPSS focused on the puncture technique,.the effectiveness and various influential factors. 68 patients were male,and 18,female with mean age of 48 years(range,22-74 years).71 patients had history of hepatitis B. 69 cases had recurrent bleeding from gastro-eseophageal varices,58 of them received more than once endoscopic sclerotherapy. 6 patients were treated on an emergency basis because of massive active bleeding. All patients had obvious gastroeseophageal varices. TIPSS was technically successful in 78 of 86 pa- tients,no death was associated with the procedure. Portal vein pressure was reduced from 40.5± 3. 0cmH_2O(1cmH_2O=0.098kPa) before to 24.0±3.5cmH_2O after shunting,Doppler US revealed that the maximum blood flow velocity in the main portal vein increased from 12.0±4.5cm/s to 48.5 ±14,5/s. The mean follow-up time in the successful cases was 8 months(range,2-16 months).Shunt occlusion was found in 2 patients 1 month after TIPSS.3 patients died unrelated to the proce- dures at 2 months. 7 cases were lost to follow up and the remaining 66 patients had regular follow up records,6 patients had recurrence of gastrointestinal bleeding within six months,the cause was 8hunt occlusion in 2 cases and shunt stenosis in another 2 whchwere reintervented successfully. Variceal bleeding was confirmed in 1 case by endoscopy,another bleeding was unrelated to varices. Varices recurred but without recurrent bleeding in 3 patients 4～7months after shunting. Angiogra- phy revealed>70%stenosis in 2 cases, which were successful treated.Shunt patency was determined by color Doppler US in the remaining patients.The overall primary patency was 87.9%;Angioplasty and stent placement in the stenotic shunt resulted in a secondary patency of 93.9%. The results sug- gested that TIPSS is a relatively safe and effective means of lowering portal pressure and controlling variceal bleeding. The immediate and short-term results were mainly affected by improper stent placement and some un

关 键 词：经颈静脉 肝 介入疗法 门腔静脉分流 疗效 

分 类 号：R657.34[医药卫生—外科学]