急诊 TIPSS 在控制食管胃底静脉曲张破裂大出血中的应用及意义  

Transjugular intrahepatic portosystemic stent shunt:results in the treatment of 22 emergency patients

作　　者：张金山[1] 王茂强[1] 杨立[1] 邢冲冲[1] 于淼[1] 崔志鹏[1] 王艳萍[1] 

机构地区：[1]解放军总医院放射科

出　　处：《中华放射学杂志》1997年第5期303-306,共4页Chinese Journal of Radiology

摘　　要：目的：观察食管胃底静脉曲张破裂大出血患者行急诊经颈静脉肝内门腔静脉内支架分流术（ＴＩＰＳＳ）的治疗效果，并讨论急诊ＴＩＰＳＳ在方法学方面的特点。材料与方法：２２例患者因食管胃底静脉曲张破裂大出血接受急诊ＴＩＰＳＳ治疗。术中同时行胃冠状静脉和（或）胃短静脉栓塞。３例存在自发脾－肾或胃－肾分流道者，在球囊导管闭塞分流道肾端的前提下，行经分流道逆行胃底静脉曲张栓塞。结果：２２例中，１９例止血成功；１６例建立分流道；术后２４小时再发出血４例，其中２例死亡。结论：急诊ＴＩＰＳＳ是治疗食管胃底静脉曲张破裂大出血的有效方法。在方法学方面，急诊ＴＩＰＳＳ强调尽量通过可能途径栓塞曲张静脉，以获得及时、可靠的止血效果。Purpose: To evaluate TIPSS in the treatment of emergency patients suffering from portal hypertension and acute gastroesophageal variceal bleeding, and to compare emergency procedure with selected TIPSS placement in patient selection and methodology. Materials and methods: A series of 22 emergency patients suffered from portal hypertension and life threatening gastroesophageal variceal bleeding uncontrollable to conventional therapy was treated with TIPSS and embolization of bleeding varices. Embolization through spontaneous spleno renal shunt/gastro renal shunt (SSRS/SGRS) with the distal end of the spontaneous shunt occluded by a balloon catheter was done in 3 cases. Results: In patients, embolization was performed through the spontaneous shunt. Bleeding ceased immediately in 19 of 22 patients. Rebleeding occurred in 4 cases within 24h after treatment, resulting in death in 2 patients. Conclusion: TIPSS combined with embolization is a useful and effective method in the management of life threatening bleeding of gastroesophageal varices. In case of emergency, contraindication shoud not be taken as strictly as in selected patients.

关 键 词：TIPSS 食管胃底 静脉曲张 出血 

分 类 号：R655.4[医药卫生—外科学] R656.6[医药卫生—临床医学]