经颈静脉肝内门体静脉分流(TIPS)术后并发肝性脑病的临床分析  

Clinical analysis of hepatic encephalopathy after Transjugular intrahepatic portosystemic shunt (TIPS)

作　　者：赵延军[1] 韩国宏[1] 殷占新[1] 何创业[1] 白飞虎[1] 李瑞军[1] 白苇[1] 牛静[1] 郭文刚[1] 

机构地区：[1]西安市第四军医大学西京医院消化病研究所介入诊疗中心,陕西710000

出　　处：《当代医学》2010年第11期139-141,共3页Contemporary Medicine

摘　　要：目的研究经颈静脉肝内门体静脉分流(TIPS)术后患者肝性脑病的发生机制及与手术方式/支架规格的关系,改进TIPS手术。方法对我科1999～2006年间225例患者的术前及术后肝功、血氨,及手术中使用支架规格,穿刺门静脉情况,曲张静脉栓塞情况等资料进行统计、分析。结果行TIPS术后临床症状和体征均得到不同程度改善,急诊出血停止,腹水逐渐消退。穿刺门脉左支患者肝性脑病发生率明显低于穿刺门脉右支。使用8mm支架肝性脑病发生率亦明显低于使用10mm支架。结论选择门静脉左支作为门腔静脉分流道,植入8mm内径血管支架,可以显著降低肝性脑病发生率,并保护肝功能,而对分流道远期开通率无明显差异。Objective To improve the surgery of transjugular intra–hepatic portosystemic shunt （TIPS）,reduce the incidence of hepatic encephalopathy and hepatic myelopahty after operation and promote the clinic and basic research by analyzing the data of patients after TIPS and summarizing factors causing hepatic encephalopathy and hepatic myelopahty after operation. Methods The data of liver function and blood ammonia before/after operation,shunt specifications,conditions of portal vein puncture and thrombosis of varicose veins were analyzed. Results Clinical symptoms and signs were improved at varying degrees,emergent bleeding was stopped,ascites gradually subsided. The incidence of hepatic encephalopathy in patients with puncture in left branch of portal vein were significantly lower than that in right branch portal vein. The incidence of hepatic encephalopathy in patients with 8mm stents were significantly lower than those with 10mm stents. Conclusion The incidence of hepatic encephalopathy can be reduced significantly by choosing 8mm stent and left branch of portal vein as portal vein shunt passage. It can also protect liver function but there is no significant difference of further open rate.

关 键 词：TIPS术 肝性脑病 门体分流术 介入性放射学 

分 类 号：R575.2[医药卫生—消化系统] R747.9[医药卫生—内科学]