TIPS 若干问题探讨  

Investigation on the clinical application of TIPS

作　　者：杨建勇[1] 冯敢生[1] 梁惠民[1] 周汝明[1] 郑传胜[1] 吴汉平[1] 侯晓华[1] 

机构地区：[1]同济医科大学附属协和医院放射科

出　　处：《中华放射学杂志》1997年第5期298-302,共5页Chinese Journal of Radiology

基　　金：国家自然科学基金

摘　　要：目的：分析门脉高压患者行经颈静脉肝内门体静脉分流术（ＴＩＰＳ）治疗的临床资料，了解影响操作成功率及并发症、临床疗效、肝性脑病（ＨＥ）发生等的相关因素。材料与方法：３８例肝硬化门脉高压患者接受ＴＩＰＳ治疗。采用透视及Ｂ超联合导向法指导肝内门静脉穿刺。ＴＩＰＳ前后定期测定肝功能、血氨等生化指标。术后定期随访临床情况、肝功能分级改变，每３个月复查Ｂ超一次，测定支架内流速、直径，每半年进行一次直接门脉造影并测定门体静脉压力差。结果：首次操作成功率９７％，未发生操作引起的并发症，ＴＩＰＳ后门体静脉压差从平均３．２０ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）下降到１．７５ｋＰａ（Ｐ＜０．００１），未发生急性再出血，１例在术后第１０个月因支架内狭窄发生再出血。ＴＩＰＳ前后病人肝功能分级、血氨变化无显著差异，肝性脑病发生率为１０％，与术前肝功能分级、术后血氨变化无明显关系，ＨＥ病人中的门脉血流值明显高于未发生ＨＥ的病例。结论：（１）超声配合透视实时导向对提高操作成功率，减少并发症及提高远期疗效具有重要意义；（２）严格定期复查及必要的再次介入处理是目前预防分流通道再狭窄，保证临床疗效的重要措施；（３）肝性脑病的发生与病人肝功能分级关?Purpose: To investigate the therapeutic results, complications and some clinical items including hepatic encephalopathy (HE) after TIPS procedure. Materials and methods: Thirty eight patients with cirrhotic portal hypertension and gastro esophageal varices were treated with TIPS. The TIPS procedure was done under the guidance of combined use of ultrasound and fluoroscopy. Follow up was made by ultrasound in 3 month interval and direct portography in 6 month interval. Results: Procedure success was 97% and no procedure related complication. The pressure gradient decreased from 3.20 kPa to 1.75 kPa ( P <0.001). There was no recurrent bleeding within 1 month. One patient had variceal bleeding 10 months after TIPS because of restenosis. 10% of patients developed encephalopathy which had no positive correlation to Child Push class. The value of portal blood flow was significantly higher in those patients who developed hepatic encephalopathy. Conclusion: (1) Combined use of ultrasound and fluoroscopy made the procedure easier and safer and also reduced complications; (2) Follow up within one year using portography, and measurement of pressure gradient were important for maintaining long term patency of TIPS; (3) Hepatic encephalopathy after TIPS had no significant relation to liver function grading and ammonia level, but was related to decrease of liver blood flow and exhibited a positive relation to the flow speed in stent.

关 键 词：介入性放射学 门腔静脉分流术 门脉高血压 

分 类 号：R657.340.5[医药卫生—外科学]