经颈内静脉肝内门体分流术联合胃冠状静脉栓塞治疗食管胃底静脉曲张疗效分析  

Transjugular intrahepatic portosystemic shunt plus embolotherapy in the treatment of gastroesophageal varices： a report of 38 patients

作　　者：王洪波[1] 张安忠[1] 杨崇美[1] 崔屹[1] 张俊勇[1] 刘福利[1] 张春清[1] 

机构地区：[1]山东大学附属省立医院消化科,济南250021

出　　处：《中华医学杂志》2012年第6期411-413,共3页National Medical Journal of China

摘　　要：目的评估经颈内静脉肝内门体分流术（TIPS）联合胃冠状静脉栓塞术治疗食管胃底静脉曲张的疗效。方法对2005年7月至2011年3月山东大学附属省立医院36例肝硬化食管胃底静脉曲张患者行TIPS联合胃冠状静脉栓塞术治疗，术后7d复查腹部超声及肝功能、血常规等检查，术后1个月复查胃镜观察患者食管胃底静脉曲张变化情况，并随访3～6个月观察再出血及并发症的发生情况。结果TIPS联合胃冠状静脉栓塞术的技术成功率为100％，术前门静脉主干压力为：（284-8）mmHg（1mmHg=0．133kPa），术后下降至（144-7）mmHg。造影见食管胃底曲张静脉消失，术后患者肝功明显改善，食管胃底静脉曲张程度明显减轻。术前Child．Pugh分级A级21例，B级11例，C级4例，术后3个月Child-Pugh分级A级29例，B级5，C级2例。患者腹水明显减轻甚至消失；脾功能亢进亦得到明显改善，表现为术后脾脏缩小，血小板数目由术前（454-20）×109／L增加至（59±15）×109／L。随访3～6个月，其中4例患者术后出现肝性脑病，经治疗后缓解，1例患者术后出现分流道狭窄，再次置入支架后狭窄再通。半年内无食管胃底静脉曲张破裂出血发生。结论TIPS联合胃冠状静脉栓塞术能有效降低门静脉压，控制并预防食管胃底静脉曲张破裂出血，手术成功率高、并发症少，术后复发率低，具有重要的临床应用价值。Objective To evaluate the efficacy of transjugular intrahepatic portosystemic shunt （TIPS） plus embolotherapy in the treatment of patients with gastroesophageal varices. Methods A total of 36 patients with gastroesophageal varices underwent the therapies of TIPS plus embolotherapy from July 2005 to March 2011 at Provincial Hospital Affiliated to Shandong University. The rechecked items included abdominal ultrasound examination, liver function test and blood routine examination at Day 7 post-operation. All received endoscopic examinations at Month 1. Results The technical success rate of TIPS plus embolotherapy was 100%. The portal vein pressures declined from （28± 8 ） mm Hg（ 1 mm Hg = 0. 133 kPa） to （14 ±7 ） mm Hg at post-operation. Angiography showed gastroesophageal varices disappeared in all patients. Both liver function and gastroesophageal varices markedly improved. During the follow-up period of 3 -6 months, 4 cases had hepatic encephalopathy and 1 case stent restenosis at post-operation. And most cases were resolved after treatment. No rebleeding occurred during the follow-up period. Conclusions The combined modality of TIPS plus embolotherapy can effectively lower portal vein pressure and cure esophageal and gastric varice bleeding. As a safe and excellent interventional procedure with fewer complications and a lower recurrence rate of portal hypertension, it has great clinical values in the treatment of nortal hvnertension and gastroesophageal varices.

关 键 词：门体分流术 经颈静脉肝内 栓塞 食管和胃静脉曲张 

分 类 号：R571.3[医药卫生—消化系统]