TIPS加断流术与脾肾分流加断流术治疗门静脉高压症疗效分析  

A comparison of effects between TIPS plus porto-azygos devascularization and splenorenal shunt plus porto-azygos devascularization in the treatment of portal hypertension with variceal bleeding

作　　者：吴性江[1] 韩建明[1] 曹建明[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院普通外科,江苏南京210002

出　　处：《外科理论与实践》2008年第3期205-209,共5页Journal of Surgery Concepts & Practice

摘　　要：目的:分析TIPS加断流术与脾肾分流加断流术治疗门静脉高压症的临床疗效。方法:1998年12月至2007年12月,60例门静脉高压症病人经血生化、钡餐或胃镜、多普勒超声及CTA检查后,根据病人的全身和肝功能状况,分为A、B两组。A组(30例)行TIPS加断流术,B组(30例)行脾肾分流加断流术。结果:A组门静脉压力由术前(41.5±5.2)cmH2O降至术后的(32.8±6.08)cmH2O(P<0.01),门静脉血流速度由术前(17.1±4.5)cm/s升至术后的(38.3±5.3)cm/s(P<0.01);B组门静脉压力由术前(43.3±6.2)cmH2O降至术后的(34.8±4.3)cmH2O(P<0.01),术前、术后门静脉血流速度分别为(18.6±7.5)cm/s和(20.6±5.9)cm/s(P>0.05)。A组手术成功率、分流道通畅率、并发症发生率和手术死亡率分别为100%、100%、23.3%和3.3%,B组则分别为86.7%、80.8%、23.3%和3.3%。术后随访,A组分流道阻塞、出血复发、肝性脑病的发生率和5年生存率分别为27.6%、6.9%、24.1%和79.3%,B组则为5.0%、8.0%、8.0%和80.0%。结论:TIPS加断流术与脾肾分流加断流术均能有效地控制食管静脉曲张出血,前者特别适用于急性出血的治疗,后者具持久的分流道通畅率。Objective To compare the effects between TIPS plus porto-azygos devascularization and splenorenal shunt plus porto-azygos devascularization in the treatment of portal hypertension with variceal bleeding. Methods From Dec, 1998 to Dec, 2007, sixty patients with portal hypertension and variceal bleeding were admitted. Biochemical tests, upper G-I barium meal or endoscopy, Doppler ultrasound and CTA were performed. According to the patients＇ general condition and Child-Pugh grade, they were distributed to undergo TIPS plus porto-azygos devascularization （group A, n=30） or splenorenal shunt plus porto-azygos devascularization （group B, n=30）. Essential points in terms of recurrent variceal bleeding, post-operative encephalopathy, as well as long-term survival, stenosis, of the shunt created and the portal hemodynamics were evaluated. Results Post-operatively, the portal pressure in group A was reduced from the preoperative value of （41.5±5.2）cm H2O to （32.8±6.1）cm H2O （P〈0.01）, and the velocity of portal blood flow was increased from the pre-operative value of （17.1±4.5）cm/s to （38.3±5.3）cm/s（P〈0.01）; and the portal pressure in group B from （43.3± 6.2）cm H2O to （34.8±4.3）cm H2O（P〈0.01）, and the velocity of portal blood flow from （18.6±7.5）cm/s to （20.6±5.9）cm/s（P〉 0.05）. The rates of operative success, shunt patency, complications, and mortality were 100%,100%,23.3% and 3.3% in group A and 86.7%,80.8%,23.3% and 3.3% in group B respectively. During the long-term follow-up, the rates of shunt occlusion, rebleeding, encephalopathy and survival were 27.6%,6.9%,24.1% and 79.3% in group A and 5.0%,8.0%,8.0% and 80.0% respectively in group B. Conclusions TIPS plus porto-azygos devascularization and splenorenal shunt plus porto-azygos devascularization were similarly efficacious in the control of refractory variceal bleeding. TIPS plus porto- azygos devascularization is preferable for the management of active variceal bleeding, while splenorenal shunt

关 键 词：高血压 门静脉 断流术 外科 脾肾静脉分流术 外科 门体分流术 外科 

分 类 号：R657.34[医药卫生—外科学]