经颈静脉肝内门-体静脉分流术应用疗效观察  

Transjugular Intrahepatic Portosystemic Stent Shunts: Early Clinical Experience

作　　者：张金山[1] 王茂强[1] 杨立[1] 邢冲冲[1] 于淼[1] 崔志鹏[1] 黄英才[2] 张正友[2] 

机构地区：[1]解放军总医院放射科,北京100853 [2]解放军总医院消化科

出　　处：《中国医学影像学杂志》1993年第1期33-36,共4页Chinese Journal of Medical Imaging

摘　　要：本文报告经颈静脉肝内门-体静脉分流术(TIPSS)14例,成功12例。术后食道静脉曲张明显减轻乃至消失、门脉主干血流速度显著增加、门脉压力平均下降1.48kPa、血小板有所升高、白细胞变化不大、脾脏体积缩小30-60％。本组临床应用结果表明:TIPSS创伤性小,降低门脉压可靠,是治疗门脉高压症的有效方法;此技术成功的关键是术前了解肝静脉与门静脉的空间关系。This paper reported the clinical results of fourteen consecutive TIPSS procedures. Eleven were male, three female with mean age of 48 years (range 24-64 years). All patients had cirrhosis with portal hypertension and varices. Ten cases had recurrent bleeding for gastroesophageal varices. The results showed that shunts were completed in twelve of fourteen patients, no death was associated with the procedure. Portal pressure was reduced from 3.63-4.80Kpa before shunting to 2.35-2.84kPa after shunting, Doppler US revealed that the maximum blood flow velocity in the main portal vein increased from 11 -23cm / sec to 34-72cm / sec. The mean follow-up time in the successful cases was 4 months (range, 2-7.5 months). The shunt patency was determined with Doppler US in eleven patients, occlusion of the tract was found in one. Mild ascites in 3 cases resolved, varices disappeared completely in 6 patients and abated obviously in 5 patients. The initial results suggest that TIPSS be a safe and effective method of portal decompression for the treatment of variceal hemorrhage, and that the key to TIPSS be understanding the 3-dimensional relationships between hepatic and portal veins.

关 键 词：经颈静脉肝内门-体静脉分流术 疗效观察 食道静脉曲张 白细胞变化 TIPSS 降低门脉压 门脉高压症 血流速度 门脉压力 体积缩小 临床应用 有效方法 空间关系 血小板 创伤性 门静脉 肝静脉 

分 类 号：R575.2[医药卫生—消化系统] R571.305[医药卫生—内科学]