经颈静脉途径肝内门体分流术  

Transjugular intahepatic portosystemic stent shunts

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

机构地区：[1]中国人民解放军总医院放射科

出　　处：《中华医学杂志》1994年第3期150-152,T018,共4页National Medical Journal of China

摘　　要：作者报告１６例经颈静脉途径肝内门体分流术（ＴＩＰＳＳ）的临床应用结果，旨在探讨穿刺技术和评价近期疗效。结果：１４例成功，２例失败，尤死亡并发症。建立分流后门脉压从术前３．９８±０．２４ｋＰａ降至２４０±０．１６ｋＰａ，Ｄｏｐｐｌｅｒ超声显示门脉主干血流速度从术前１４．０±４．５ｃｍ／ｓ增至４８．０±１６．５ｃｍ／ｓ。术后随访观察２～７．５个月（平均４．５个月），除１例分流道早闭外，其余保持通畅；７例静脉曲张近乎完全消失，６例明显减轻，４例术前少量腹水于术后消失；随访期间无复发出血及肝性脑病发牛。结论：ＴＩＰＳＳ创伤性小、降低门脉压可靠，是治疗门脉高压症的优良方法；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；为建立有效分流，作者推荐用直径１２ｍｍ内支架。e studied the clinical and procedural results oftransjugular intahepatic portosystemic stent shunts(TIPSS) procedures in 16 patients, of whom 13 weremale, 3 female, with mean age of 48 years (range 24 ￣66). All patients had cirrhosis with portal hypertensionand varices. Twelve patients had recurrent bleeding forgastroesophageal varices. The results showed thatshunts were successful in 14 of the 16 patients, andthat no death was due to the procedure. Portal veinpressure was reduced from 3.98± 0.24 kPa beforeshunting to 2.40± 0.16 kPa after shunting. Dopplerultrasound revealed that the maximum blood flow ve-locity in the main portal vein increased from 14.0±4.scm / s to 48.0± 16.scm / s. The mean follow-uptime in the successful cases was 4.5 months (range, 2￣7.5). The shunt patency was determined with colorDoppler ultrasound in 13 patients, and occlusion ofthe tract was found in one. Mild ascites resolved in 4patiants; vances disappeared in 7 patients and abatedin 6. No bleeding or encephalopathy was noted duringthe followup. The results suggested that TIPSS is asafe and effective method for portal decompression inthe treatment of variceal hemorrhage, and that the keyto TIPSS is understanding of the 3-dimensional rela-tionships between hepatic and portal veins. To achievean adequate shunt, we recommend that stent with12mm in diameter should be used.

关 键 词：门脉系统 分流术 门脉高血压 

分 类 号：R657.34[医药卫生—外科学]