经颈静脉肝内门腔静脉内支架分流术(TIPSS)治疗门脉高压症(附215例分析)  

Review of the transjugular inirahepatic portosystemic stent shunt (Tipss) in treatment of portal hypertension in the past 12 years (analysis of 215 cases)

作　　者：薛挥[1] 吕良山[1] 郝志明[1] 乔文[1] 厉英超[1] 贾皑[1] 焦捷英[1] 段荣[1] 

机构地区：[1]西安交通大学医学院第一附属医院消化内科,陕西西安710061

出　　处：《中国现代医学杂志》2007年第15期1863-1866,1869,共5页China Journal of Modern Medicine

摘　　要：目的评估经颈静脉肝内门腔静脉内支架分流术(transjugular intrahepatic portosystemic stent shunt,TIPSS)在治疗门静脉高压症的作用和地位。方法总结分析215例门静脉高压症接受TIPSS治疗患者临床资料。结果术前曾行外科脾切除加断流术12例,行食道曲张静脉套扎、硬化58例。手术成功率90.70%(195/215),TIPSS188例,经肝段下腔静脉穿刺门脉建立TIPSS分流(TCTIPSS)7例。术前平均门静脉压力由(3.65±0.70)kPa降至术后的(2.15±0.68)kPa(P<0.01)。3例出血患者急诊行TIPSS治疗均成功止血,顽固性胸腹水缓解率80%(4/5)。一过性肝性脑病(HE)占35.38%(69/195),复诊者支架狭窄22例,其中再出血住院7例,有8例分流道再成形。术后5年生存率占31.27%(61/195),存活超过10年1例,接近9年3例。与操作相关的死亡2例,均系穿破肝包膜并肝素使用后致腹腔出血不止。近期(3个月内)死亡10例,占5.13%(原因包括穿破肝包膜2例,术后镇静剂安定使用2例,利尿剂未减量致电解质严重紊乱1例,术前顽固性胸腹水术后肝功能衰竭5例)。死亡病人中生存最长9年1例(死于结肠癌术后),有3例(存活6年、7年、8年)分别死于干扰素使用后肝功能衰竭和旅游性腹泻。结论TIPSS治疗门静脉高压症疗效肯定,并发症少,防治出血更符合卫生经济学。术后应禁用镇静剂,慎用利尿剂,门静脉穿刺困难者即刻不抗凝须小心。[Objective] To evaluate the effect of transjugular intrahepatic portosystemic stent shunt （TIPSS） in the treatment of portal hypertension. [Methods] 215 cases of portal hypertension accepting TIPSS were summarized and analysed. [Results] Before TIPSS, 12 cases underwent surgical splenectomy and variceal transection, and 58 cases underwent band ligation and seleretherapy of the varices. The successful rate was 90.70% （195/215）. 188 cases underwent TIPSS, and 7 cases underwent transcaval transjugular intrahepatic portosystemic stent shunt （TCTIPSS）. Mean portal pressure dropped from （3.65±0.70） kPa to （2.15±0.68） kPa after operation （P 〈0.01）. The successful rate of emergency hemostasis was 100%, and the relief rate of refractory ascites was 80% （4/5）. The rate of temporary hepatic encephalopathy was 35.38% （69/195）. 22 cases presented with stent stenosis in the follow-up, 7 cases presented with rebleeding and rehospitalization, and 8 cases presented with angioplasty. The survival rate in 5 years was 31.27% （61/195）. There were 1 case surviving for more than 10 years and 3 cases for about 9 years after TIPSS. 2 died cases associated with the manipulation were due to puncturing and breaking hepatic capsule as well as the injection of heparinate causing abdominal bleeding. The early mortality （died within 3 months） was 5.13% （10/195）, including 2 cases of hepatic capsule injury, 2 cases of sedative use, 1 case of diuretics causing severe electrolyte confusion, and 5 cases of accompanying refractory ascites and hepatic dysfunction after operation. The longest survival time in died cases was over 9 years and this patient died of the postoperation of colonic cancer. There were 3 cases （surviving for 6, 7, and 8 years） died of hepatic dysfunction after the use of interferon and traveling diarrhea respectively. [Conclusion] TIPSS is available and satisfactory in the treatment of portal hypertension with fewer complications, and it is more appropriate to sanitation econom

关 键 词：门静脉高压 经颈静脉肝内门体内支架分流术 肝硬化 

分 类 号：R657.3[医药卫生—外科学]